Tag Archives: therapy

Epistemically Honest Reassurance

There’s a problem I’ve been seeing a lot since I started doing couple’s counseling with rationalists: we are, on the whole, uncomfortable with lying, particularly to people we care about, even if it’s for a good cause. Being put in a position where someone asks you to lie to them can feel like a gear grinding in the head, or a disembodying from your true self, or a sense of suddenly walking on eggshells.

Not just rationalists feel this way, of course, but the following exchange is nearly ubiquitous in normal romantic culture:

“Do you think [bad thing will happen]?”

“Of course not, everything will be fine.”

On an intellectual level, the person asking often knows that their partner can’t actually promise this. But for many people, particularly in times of crisis, words to the effect of “Everything will be fine” are comforting, and all they’re really asking for in that moment is emotional reassurance. There’s nothing wrong with that, any more than there is a desire for aspirin when you have a headache.

Meanwhile, this is what might happen for rationalists:

“I’m scared of [bad thing happening].”

“Well, there’s a chance that it does, of course, but on net it doesn’t seem likely.”

or, if it does seem likely:

“Well… [brain lock]… Uh… [something meant to be reassuring but undermined by tone and affect].”

And sometimes the issue isn’t even about probabilities at all:

“Have I gained weight/does this make me look fat?”

“Are we going to be together forever?”

“Do you think they’re more attractive than I am?”

“Does it bother you when I get really sad for no reason?”

Again, it’s taken as the default in general romantic culture that what matters in responses are that they are reassuring, not that they’re true. Most people in normal culture would react with indignant outrage on their friend’s behalf if told that a spouse gave an honest answer to any of the above that reaffirmed the insecurity.

And again, even for other rationalists, the person asking may know that they’re putting their partner in a double bind, but the thing they want is not actually a “comforting lie.” Many people, particularly rationalists, really appreciate a partner who will be scrupulously honest with them.

But what still matters more than the object-level question is answering the implicit query:

“[I’m feeling insecure; do I have reason to be?]”

Which is why it might help to see the desire for verbal reassurance as similar to the desire for a hug; it’s about the sensation and the signal, and those can be provided without saying anything that feels false.

How Do?

First, its important to reiterate that this is meant to be a way to reassure someone who is having a bad time, not a method of “fixing” underlying insecurities. Everyone needs a hug now and then, and sometimes all you can do for a cold is pop some aspirin. If there seems like a deeper issue at play then resolving that requires more in-depth discussion than this article is going to cover.

Second, I am not suggesting platitudes. If you can’t think of something both honest and reassuring to say, that’s a separate problem; if your partner wants reassurance that you love them or are committed to the relationship, and you can’t give that, don’t make it seem otherwise.

Third, remember to be ready to reverse all advice. Some people do actually want to be told “Yes, that makes you look fat.” But hopefully you will learn this through the relationship itself, and often even in those cases people don’t just want radical honesty, but also reassurance and understanding; this article is trying to help those who have already tried addressing the object-level and found their partner wasn’t reassured, without ignoring the possibility that they did in fact want object-level reassurance about improbability and wanted more emotional reassurance.

Speaking of which… a related problem is the one where people are unsure if their partner wants to “vent” or “problem solve,” and this post has advice on that which is very relevant here too.

…my answer is almost always “I want to understand my problem better, feel understood, and be reassured that the people important to me agree that this is a real problem, or at least that they support me in general. If understanding itself doesn’t solve the problem I will want to problem solve after I understand it”.

Similarly, people expressing insecurity through unanswerable questions often want to feel understood, and reassured, and maybe then also problem solve. That might look something like:

Am I getting fat?

What’s making you think that?

I no longer fit into these pants.

I’m sorry, I know you like those pants. I think you look great, but maybe we can find another pair you might like as much?

But that’s a nuanced and context dependent maneuver, not a one-size-fits-all password. The point of this post is to highlight to those who ask questions like this why their partner might have trouble answering them, and help those who are asked these questions understand what’s really being asked for is not always an answer to what’s being asked.

The root generator you want to tap into here is the one that creates your own optimism. What do you feel good/safe/confident about that you can share with your partner? What truth about yourself or your relationship do you want them to take comfort from?

“Do you think I’m going to get long COVID?”

“Either way, I’m here for you. We’ll get through it together.”

“Are you attracted to them?”

“Not the way I am you. You’re the only one I want to be with.”

“Do you think we’re going to make it through this?”

“I don’t know what the future holds, but I’m with you because I believe in us.”

“I hate how depressed I get all the time. I feel like I’m never going to be ‘normal.’”

“I know that must be frustrating, but I want you to know that I love you, and feel so lucky to be with you.”

And so on. For that last one, conversely, a bold prediction like “Don’t worry, I’m sure you will someday” could be counterproductive even in normal romantic culture. Some might want that object-level reassurance, but for others it would be missing the point;  the actual thing they want is, again, to know that your love and support isn’t dependent on that happening.

Remember, try to find words that are true for you and feel right for your partner, and stay curious about what your partner is actually seeking in those situations; it may change over time, or be different in one context vs another. Then, once the moment is past, talk to them about it! Ask them what they felt when they asked something, what they meant by it, how your response was, what they would like to hear more of or less of.

There are also of course physical things you can and should do as well; touch is important for comfort and reassurance, as are gifts and acts of service. If you own a scale and your partner asks “Have I gained weight,” there are some pretty good ways to show that you find your partner attractive, and that question is a decent signal that you should do them more often.

Emotional/IFS Integration 102

(This is going to be another brief + tips oriented review of IFS concepts; be sure to read the 101 post if you’re totally new to this)

Not all parts that can exist inside you are naturally there or equally fleshed out. Circumstances in life will strengthen one or another, but like the saying about the two wolves inside us, you can also intentionally “feed” specific parts to make them stronger, and there’s one part in particular that your whole system will benefit from having strong.

Some call it the Ideal Parent Figure, others the Ideal Future Self, Inner Champion, Inner Mentor, etc. By some interpretations these could be considered “guides” or “critters” or “voices” rather than parts, in that they may speak to you but not want to act on their own, but that might vary per person. Additionally, their roles are subtly different based on the internal system they’re part of, but are still broadly those of Mediator, Comforter, and Encourager, whose primary value is their endless compassion for you and your parts.

Self-compassion is crucial to IFS, not as a prerequisite but as the primary ingredient for true acceptance of your parts/emotions, productive forgiveness for your mistakes, and a dignity that no one and nothing in life can take away from you. When you unconditionally love yourself, all sorts of healing and growth become possible, and you can create much stronger boundaries between yourself and harm.

Developing and feeding these inner parts can look similar, but experimentation can help find which works best for you. For this post I’ll just give brief advice for the first two:

Ideal Parent Figure is often a source of compassionate mediation between your parts. It helps you bring the Exiles in from the cold, soothe Anxiety’s fear of being ignored, understand Anger’s justifications, relax Firefighters’ vigilance, etc. Those who had abusive or distant parents often don’t know where to start with constructing this, unless they’re lucky enough to have met a friend’s parent or other mentor in their life who can serve as a model. Fictional characters can work too; Mr. Rogers is an example of someone widely considered a “platonic parental figure,” and many have found comfort and self-compassion by internalizing his “voice” and perspective to help replace some of the more harmful self-talk and their own (often well intentioned) imperfect parents left them with. You can also use this Protocol to help visualize what having a part like this could actually look like.

Ideal Future Self in many internal systems (my own included) serves identical purposes to the IPF; it’s particularly useful for those who had no sense of “parents” as a distinct emotional category, positive or negative, by instead drawing directly on your aspirations. Constructing and feeding your Ideal Future Self is done by thinking over and writing out what a version of you with all the skill and wisdom that you hope to develop would say if they were around and freely able to give it to you, all in a compassionate way. Your ideal self would not judge any shortcomings and failings you have, because they remember your journey and all the difficulties you struggled with along the way. They serve less often as the mediator for your other parts (those without “parent” as emotional category are more likely to act as their own internal mediator), and more a source of encouragement for you; they believe in you, and care about you, and are waiting for you, no matter how long it takes. This means that you can also develop them by writing to your past self, and telling them what you wish someone had told you, particularly in your darkest moments. Like with the IPF, it can often be very healing to deliberately imagine yourself hugging your past self as you deliver the words, and similarly imagine your future self using soothing touch as they comfort and encourages you.

Psychologically, whatever this part is called, it acts as a container for all the things you intellectually might believe, but still have trouble emotionally accessing at all times, particularly at your low points.  Samples of the sorts of things they would often say include:

  • “You don’t have to be perfect to deserve love and kindness.”
  • “I know it’s hard, but I’m proud of the progress you’re making.”
  • “There’s nothing wrong with your wants/feelings, even if they’re confusing.”
  • “You made a mistake, but it doesn’t have to define you.”
  • “You can get through this. I believe in you.”
  • “It’s okay to hurt. I’m here. We’ll get through this together.”

It’s okay if you don’t believe these just yet, or if there are other voices shouting the opposite. The purpose of taking time to better build up these models and strengthen these parts is to help make these feel more real, particularly if you have memories of times they did feel true and spend time meditating on those experiences.

Once these parts are solid enough, they make practically every other aspect of emotional integration easier. It’s quite literally like having a perfect ally travel everywhere with you, ready and waiting to step in and help you whenever you need a steadying hand and comforting word.

(For further reading, here’s a good overview for why self-love and self-compassion is so powerful, with more good resources at the end.)

Emotional/IFS Integration 101:

(The following is my own understanding and practice of IFS, and may include elements that conflict with the standard model. In an attempt to keep these brief I won’t be going into much theory, and focus on what seems to work best for myself and my clients)

Internal Family Systems is a form of therapy that treats psychological or emotional difficulty as the result of disagreements between the “parts” that make you who you are. Sometimes these parts make themselves known as (disagreeing/discordant) thoughts, other times as (conflicting/painful) emotions. A variety of labels can be useful to identify and understand their effects and interactions; in the classic model, these are Exiles, Firefighters, and Managers, as well as the Self, which is the “part” that your conscious mind remains associated with even amidst fragmentation.

But there are many forms IFS can take, or layers that can be applied onto each other. For some, characterizing their parts as actual family members (Child, Teenager, Adult) is very useful. For others, a starship crew (Security, Engineering, Science, Captain) makes for easier internal communication. Whatever form these parts take, IFS can be valuable for many purposes, but the most straightforward one is simple “emotional integration,” which is to say, conversely, feeling more like a unified individual rather than struggling with emotional turmoil over some looming decision or past action.

The path to integration looks something like this:

Acknowledge->Identify->Accept->Manage->Integrate

This is not always linear progression, as emotions and parts might shift or grow nuanced over time. It’s also uneven; you can have one emotion Integrated, while struggling to Accept another and having trouble Identifying a third.
 
Most people who struggle with emotions/parts are either trying to skip ahead, or mistakenly believe they have succeeded at one step before they actually have. It’s also not always fully in our control. It can take time to process things, particularly traumatic things, and that’s okay.
 
There are skills that help with each. Meditation and mindfulness techniques help with Acknowledging. Gendlin Focusing helps with Identifying. Eliminating “shoulds” helps with Acceptance. Note that eliminating “shoulds” includes eliminating “shouldn’ts.” Parts are what they are, even if confused/traumatized. Healing starts with compassion toward your part, or yourself for having it.
 
(This can, admittedly, be tricky if those shoulds and shouldn’ts feel like they’re coming from other parts! But your “core self” can then differentiate itself from the part that’s expressing the should, and accept both parts, the same way writers learn to harness their inner critic rather than silence or be cowed by it.)
 
Learning conflict mediation helps with Managing, whether you act as the Mediator between your parts or one of parts takes on that role. Systems theory, cybernetics, NVC, reflective listening, double crux, all that fun stuff are useful here. Again, these are learnable skills, and it doesn’t take much more work to apply them to your parts instead of other people; just extra imagination and honesty and self-compassion.
 

Finally, Integration comes from practice, patience, and trust. As I said, it’s not always a steady progression. We encounter new things, life gets messy, parts get out of sync. But trust yourself, be patient with yourself, practice the skills, and the rest of you will be ready and waiting to re-integrate until you feel like unified again.

(You can learn more about IFS from this more in-depth article)

The Bad Therapist

I often think about what makes a good therapist, and find it a hard question to answer in an organized and concise way. What’s far easier, and maybe as helpful to anyone looking for therapy, is the reverse question. So, in the style of CGP Grey’s 7 Ways to Maximize Misery, I hope this list of what makes for a bad therapist can help you find a good one.


  1. A bad therapist lacks all curiosity.

They assume that their education or experience or inherent wisdom means they just know what the client means and wants and needs, even if (sometimes especially if) the client disagrees. They rarely use reflective listening or Socratic questioning, and rather than reserving assertions for psychoeducation and normalizing, instead tell the client precisely what they think is wrong, what mistakes the client is making, and/or what the client needs to do to improve, all stated with confidence rather than as hypotheses. And if your therapist does all this within the first session? Run away.

  1. A bad therapist will not respond well to negative feedback.

They expect their therapy style and modality to be perfectly suited to any client, and are not willing to adapt or learn how to best help their client. This isn’t to say all therapists and clients are suited to each other, but if reports of dissatisfaction are  turned back on you with accusations of projection or “resistance to treatment,” that’s a great red flag to find another therapist.

  1. A bad therapist pathologizes constantly.

Anything unusual about the client, from their hobbies to their fetishes to their philosophy, is suspected of causing dysfunction regardless of whether it actually does. These therapists conform to the broader culture they’re embedded in, and act as agents of social control on all manner of moral issues, from sexuality to family dynamics to choice of profession. If your therapist speaks in clichés such as “Family always forgives” or “Marriage is a sacred bond,” find a more open minded one.  

  1. A bad therapist shames their client, or makes them ashamed of themselves.

Guilt can be a powerful generator for change, but a therapist’s role is to gently guide the client to better understand themselves, and the sometimes complex relationship between what we value and what we do. If your therapist demonizes your thoughts or feelings or desires rather than helping you better understand them, you’re dealing with another therapist too trapped in their culture or biases to properly facilitate lasting healing and growth.

  1. A bad therapist pushes their worldview onto the client. 

A religious therapist who insists that “God works in mysterious ways,” or an atheist who dismisses spiritual comforts are not only unlikely to help their grieving client of the opposite beliefs, but can cause extra harm by making them feel alienated and unheard. Finding a therapist who matches your worldview can be valuable, but any competent therapist should be able to leave theirs (mostly) at the door.

  1. A bad therapist can’t remain objective. 

Early signs of this may be a therapist who talks too much about themselves or seems overwhelmed by their client’s problems. More subtly, therapists can struggle not to triangulate with a parent or child or spouse against child or parent or spouse. It may even seem like a positive, if for example the therapist starts to act like a friend, focusing on comfort to the detriment of growth. To be clear, objective doesn’t mean perfectly balanced; sometimes objectivity requires pointing out that some mistakes are one-sided, but if you don’t feel like your therapist is making an effort to include everyone’s perspectives, find another one. 

  1. A bad therapist will insist that their model is the only one with value.

These therapists view all of mental health through a single lens, the causes and solutions to illness forced into the mold they developed during their education or personal experiences. While an expert in a specific modality can be invaluable, a professional should always be ready to refer a client elsewhere if they encounter a problem in treatment, rather than blame the client and insist they’re not understanding or not trying hard enough. 

  1. A bad therapist is okay with therapy lasting forever.

I may be being too normative here, but I think it’s suboptimal for a therapist to make no effort to set concrete goals or give the client the tools they need to move on without them. If within a month you don’t have a good sense of what it would take for you to feel satisfied ending therapy, or at least reduce the frequency of sessions, then it’s worth bringing it up yourself to see if the therapist has a sense of direction or goals in mind. Vague and subjective goals are better than nothing, but ideally there would still be some observable change in the client’s life that they can use as a metric of growth.  It’s also fine to go back to therapy every few years as needed; it’s just the unending years of therapy that, to me, indicates something suboptimal is going on.

  1. A bad therapist can’t properly balance uncertainty and responsibility. 

This is the kind of therapist who attempts to hospitalize their client due to non-critical self-harm, or for simply talking about their suicidality, rather than because there is imminent and specific threat to life. Unfortunately there is little you can do to predict that your therapist is like this ahead of time, but you can at least get a sense for how well they understand the limits of confidentiality when they explain it to you; a good therapist should clarify this distinction so their client feels safe being open about how they feel.

  1. They think therapy is about talking, not doing.

This may just be me being too normative again, but while a large part of therapy is talking, it’s been a century since Freud borrowed the phrase “Talking Cure” and ran with a model of therapy aiming purely for catharsis. I think therapy should be doing more than just venting and processing; it should also involve learning new tools to be practiced between sessions, so that you can reach a point where the therapist is no longer needed. To be clear I’m thinking in terms of suggestions rather than strict “homework,” and some clients may prefer not having even those. But if you feel like therapy isn’t doing much for you and you your hasn’t suggested things for you to do between sessions, start asking for some.


I hope people find this helpful; as I said, it’s not a great guide to help finding a good therapist, but I’ve heard enough horror stories in my professional life by this point to at least try to minimize the amount of bad ones people waste their time, money, and emotional energy with.

I should also clarify that while I hesitate to label anyone a “bad therapists” by some of these more than others, I think each of them does drastically limit the amount of people and situations a therapist can help. For example, therapists who are stuck in a certain cultural zeitgeist can still help clients who conform to that culture’s norms, and therapists who never plan to discharge clients can also still be beneficial to them; hopefully that’s why the client would keep going!

But in my experience at least, each of these represent real failure modes in the therapeutic process that can end up causing more harm than good.

As a final note, I deliberately avoided mentioning anything that would count as a violation of therapeutic ethics and professional norms. If your therapist breaks confidentiality, tries to date you, regularly misses sessions, etc, the label “bad therapist” is no longer sufficient; at that point they shouldn’t be a therapist at all, and should be reported to their licensing body.

Philosophy of Therapy

For a lot of people, therapy can be a confusing, mysterious thing of questionable value. Many have tried it when they were younger, and felt that at best it was only of minimal help, while for others it actually made things worse. In many cultures, therapy looks very different from how it’s practiced in the “western world,” and the concept of mental health itself is often treated with suspicion or dismissal. I’ve known many people who, even while not being skeptical, were still confused about what the purpose of therapy actually is, or what situations warrant seeking a therapist out.

In my practice as a therapist, I often reorient myself to the basic core of therapy, which to me is about helping people get unstuck. Sometimes the thing you’re stuck on is a recurring and disruptive emotional state, other times it’s some harmful interpersonal dynamic, and other times it’s a pattern of behavior. Whatever the specifics, there is some aspect of the client’s life that is not going the way they would prefer, and the therapist’s job is to help them find a way to change that.

What the therapy provides also varies; good therapy can create space for honest expressions of emotion, provide new perspectives or insight, and offer new “tools” for the client to use in their lives, specific behaviors or mental motions that help move past the stuckness.

Those skeptical of therapy often wonder: can’t people just talk to their friends or family if they need emotional support? Aren’t there self-help books they can try? And of course they can, and should try those things! For many people, the majority of their difficulties do not require a therapist.

Which means therapy is for what’s left. Those things that seem truly intractable, the things that you feel stuck on, which other resources have failed to help resolve.

But I’d like to demystify therapy further, and better yet, I think by better understanding what therapy is meant to do and how, people can get some of the value that therapy can provide even without going to see a therapist.

Because while much of the change in therapy comes from the therapeutic relationship itself (which is why first finding a therapist that you feel comfortable with is half the battle), for a large portion of clients I’ve seen, even just changing the frame of the problems they experience, or changing the way they view themselves in relation to their problems, actually makes the problem less sticky. A new frame can reveal more levers to pull and knobs to turn, or new vistas of the mind to explore and inhabit, that can help make the problem more manageable.

So that’s the goal of this essay. By teaching the history of the different philosophies of therapy, I want to teach you how, if you change the frame, you can change the problem.

I. History

Ask people to describe what therapy involves or “looks like,” and most who haven’t been in therapy will say something like “one person lies down on a couch and talks to the therapist, who takes notes and asks questions like ‘How does that make you feel’ and ‘Tell me about your childhood’ and ‘How do you feel about your mother?’”

This is largely the result of Hollywood Therapy, but it’s rooted in the origins of therapy, which is Freudian—what’s now called Psychoanalytic Therapy.

Sigmund Freud was the progenitor of applied psychology; the idea that we could study the way people think and feel and act, and use it to directly help them “improve” in some way. He was inspired by his mentor, a physician who helped alleviate a patient’s untreatable illness by just asking questions about her symptoms. That patient coined the term “talking cure,” and Freud took this concept and ran with it, dedicating his life to the idea that many ills people suffer are psychological in nature rather than physiological, and that just talking about them can help reduce or remove them.

Freud had a lot of ideas of his own, however, and while many them turned out to be nonsense, he also had some that turned out to be true, or at the very least, useful, such as the concept of a “subconscious,” or the idea of dividing a person’s mind into subagents (in his case, Id, Ego, and Superego). As the arrow above indicates, Freud cared almost exclusively about the past; he believed that by studying one’s childhood, the way they were raised, their early environment, or the origin of a certain dysfunctional behavior, you could identify all sorts of traumas or stresses that cause dysfunction later in life. Once identified, he believed the client would gain a feeling of “catharsis” that would start the path to healing.

Here’s where I admit that I have something of a bias against psychoanalysis.

In my view, Freud was a philosopher first and foremost, rather than a scientist. He had interesting ideas that seemed logical to him, and a scientific frame of mind, but while he pursued the application of these ideas with an admirable gusto, his documentation did not seem to aim its rigor at testing which of his ideas were true. I’m unaware of any hypotheses Freud generated that he then went on to falsify. (If you know of any, please do share them!)

Far from an attempt to bash the man, I do admire him a great deal. It’s hard to be the first person to basically invent an entire field of science and do it all perfectly such that you are simultaneously the person observing reality, coming up with ideas, and dispassionately testing those ideas, all while trying to do work as a clinician. But I believe most modern schools of therapy have picked out the gems of his work and left the rest to history lessons.

That isn’t to say this branch of therapy is all worthless. While catharsis alone generally doesn’t solve most people’s symptoms (psychosomatic illnesses like his mentor’s patient’s are in fact very rare), delving into one’s past can lead to insights into their current problems, and many do report feeling better about their problems when they have a chance to talk about them (again, credit to Freud, this would likely have been very encouraging to him when he began his work).

Additionally, as a colleague pointed out to me after reading an earlier version of this article, many modern psychoanalysts do seek to empirically test the field’s ideas in order to continue to develop evidence-based treatments, and modalities such as Transference-Focused Psychotherapy have evidence suggesting it to be at least as effective as other standards of treatment.

(A modality is a method of therapy that has a specific structure to help a client reach wellness. More than a specific intervention, modalities often include multiple interventions, as well as a particular type of relationship between client and therapist that dictates whether the therapist acts as more of a guide, partner, or authority. Each modality operates on a particular hypothesis of how therapy can help clients with certain problems.)

In any case, while psychoanalysis as practiced by Freud and his ideological descendants (Carl Jung, Anna Freud, Erik Erikson) focused so much on the client’s past, new discoveries in psychology led to therapeutic modalities that focused instead on influencing the client’s future.

Enter, the Behaviorists.

As Freud is to Psychoanalysis, so Ivan Pavlov, of dog fame, is to Behaviorism. Pavlov discovered and experimented with classical conditioning, the idea that you can pair different stimuli to influence responses. This discovery was a great boon to pet owners, but also has direct applications to therapy. One example is addiction treatment, where for example the sight or smell of cigarettes or beer is paired with something that will evoke disgust. It also led to desensitization therapy for phobias, where pairing progressively more frightening stimuli with techniques and context that help relax the client can alleviate the fear response.

These ideas were expanded by Edward Thorndike and B.F. Skinner, whose work is called operant (or instrumental) conditioning. Rather than just pairing stimuli together to affect responses, their experiments showed demonstrable effects on learning and behavior through reinforcement and punishment; in therapy the idea of using positive reinforcement to incentivize desired behavior is often helpful for children, particularly those with developmental issues.

I don’t have much to say about Behaviorism. For some things that people come to therapy for help with, it just works. For others… not so much. I think understanding the mechanisms of Behavioral Therapy is valuable for any clinician, but there’s some obvious flaws with taking it as the only avenue toward better mental health.

Unlike psychoanalysts, a straw-Behaviorist doesn’t care about your past, and talking about your traumas or “deeper issues” would often be considered a waste of time. Instead the focus is on your symptoms. No symptom, no problem, right? Just apply the right type of reinforcement to increase positive behaviors and the right type of punishment to decrease negative behaviors, and all’s well…

…for some people, at least. Behaviorists had a lot of success in some domains, particularly when the “why” of the problem didn’t actually matter to the client or issue, but obviously struggled with others. After the first World War, clinicians formally recognized PTSD, or “shell shock,” for the first time. Unfortunately, attempts to treat soldiers through psychoanalytic and behavioral therapy often failed, and so many psychologists turned clinician to help figure out how better understanding the present feelings we have, and how they impact our behavior, can lead to mental health.

Which brings us to Existential Therapy.

Rather than having a single founder, the Existential philosophy of therapy was converged upon by a wide range of psychologists and clinicians, many inspired by the writings of Kierkegaard, Nietzsche, Husserl, Scheler, Heidegger, and Sartre. These writers’ attempts to redefine our understanding of not just what it means to be human, but an “actualized” human, a healthy, thriving, happy human, were believed to have great value in clinical efforts to help those in need.

But among that foundational pantheon, the first of the Existential therapists was Otto Rank, a student of Freud who later split with him over Freud’s beliefs that a person’s “formative years” are what determine who they become. Instead, Rank believed that human development continues throughout our lives, requiring continual negotiation and renegotiation between dual yearnings for individuation and connection.

For such heresy he was excommunicated by the psychoanalytic world, but he nevertheless influenced his own “family” of psychologists, including Rollo May, Viktor Frankl, who’s more well known as the author of Man’s Search for Meaning, and Abraham Maslow, of hierarchy fame. These psychologists focused not so much on what happened in someone’s past or how to influence their future, but on their now. What do people feel like they need, that they lack? How does the client experience “need” at all? What relationship do they have with their hurts and wants, and what would be necessary for them to feel fulfilled? How do those different needs and wants conflict with each other, and how can they be better brought into harmony?

Existential therapy also marked a new dynamic between client and therapist; rather than a top-down hierarchy, where the clinician is the “expert” and the client the “patient,” what became known as client-centered therapeutic practice began to form. It placed both therapist and client as equals; the clinician has the education and skills, but the client is the expert on their own lives, of what they think and feel, and so the Existential therapist’s role is more that of a facilitator to the client’s growth.

This may seem like polite semantics, but most people who’ve been to both kinds of therapists can tell how big a difference it makes if, upon disagreeing with their therapist on something, they’re treated not like a stubborn mule who is “resistant” to change, but rather a person with agency, whose motivation to improve is taken for granted by their therapist. The philosophy also emphasizes the importance of a therapist who is willing to listen, encourage, and support the client’s personal journey to better mental and emotional health, as the client defines those things.

Under the light of Existential Therapy (and its more upbeat twin, Humanistic Therapy) there grew many techniques to help clients better understand themselves, including Carl Rogers’s “reflective listening,” which has become a staple of good therapy from every philosophy, as well as techniques to better interface with our emotions, such as “focusing” by Eugene Gendlin, which I personally have found to be one of the most generically effective tools to teach practically every client I’ve had.

Time to admit to another bias, in case it’s not clear; I’m a huge fan of existential/humanistic therapy. In my experience it has a wide “range” in what it can successfully treat, and its frame makes up an integral part of what makes modalities effective in general.

But it’s not the form of therapy I was formally educated in, and it’s not the latest form of therapy that was developed. There’s one last dimension that even existential therapists failed to engage in, and if you’re following the theme of the arrows you might have guessed it: the opposite of focusing on ourselves is focusing on everything else.

Enter Systemic Therapy (also known as Family Systems Therapy, or just Family Therapy), born in the 1950s from a very powerful need; the need for better marriage counseling.

In the post WWII era, if a husband and wife wanted to save their marriage, they would go about it thusly: the man would have his counselor, and the woman would have her counselor, and both would see their counselors separately. If they went to a fancy clinic dedicated to marriage counseling, the two clinicians would be coworkers, seeing their clients individually, then consulting on the case between sessions, or even mid-session before returning to their clients.

If that sounds crazy, just remember that this was the 50’s, when people still thought smoking was good for you. The idea was that a client’s relationship with their therapist was sacrosanct, and must always be preserved as a space of utter one-on-one privacy that would allow them to be completely frank, without worrying about their spouse’s presence, or their therapist telling their spouse anything spoken of in confidence.

Eventually some therapists in California realized how absurd this was, not to mention ineffective. They suggested a new way to practice marriage counseling, where a single counselor (or even two) spoke with both clients together, in the same room and at the same time. That way a therapist could observe their interactions and mediate their discussions directly.

Their clinic said no.

So Don Jackson and his colleagues left to form the Mental Research Institute in Palo Alto, where they developed their own modality of therapy, one that involved not just the individual patient, but sometimes romantic partners, family members, even friends if the problem called for it.

They weren’t the only ones; Salvador Minuchin, Murray Bowen, Ivan Boszormenyi-Nagy, Virginia Satir, and Jay Haley all developed modalities based on the idea that, to help a client overcome dysfunction, the therapist should focus not just on the client, but the system they’re a part of, whether that be their family, their work environment, their culture, or even their country, all at various levels of abstraction.

(There isn’t going to be a test on all the names I’m throwing at you, but if I went into every single modality we’d be here all day, and this way you have an easy way to look into them on your own if you want.)

The study of cybernetics and communication theory were also prominent influences, particularly by the anthropologist Gregory Bateson, who believed that all forms of communication are adaptive, and rejected the concepts of linear and dualistic thinking for studying systems. 

 The “systems” being referred to in these therapies can be any context you’re a part of, individually or simultaneously: family system, school system, work, friend-group, even cultural and religious. According to Bateson, being part of any system leads to  inherent and unavoidable communication between you and the other parts, implicit or explicit, which affects the other parts of the system and how they behave, which further affects how you behave, and so on. Additionally, there can be no divide between an interactive observer and participant of a system; by observing the system directly, the therapist becomes a part of it.

This understanding led to a philosophy that takes the humility of existential therapy even further,  and improved clinicians’ ability to map the impact of one part of a system on the others, such that many modalities do not even identify anyone in particular as “sick” or “healthy,” but rather views behavior patterns themselves as dynamic or stagnant, and focuses on how change can propagate through the system by nudging elements of it. By understanding how everyone’s actions and reactions affect each other’s behavior, the client and clinician have more surface area on the problem to try and find solutions, more levers to pull and handles to grip from.

A big reason why this lens can be so valuable is that when you start working with groups rather than individuals, you have to address the fact that often times, not everyone involved in therapy has the same desire to be there, let alone incentive or drive to change. Of course, that was true before couples or entire families were being invited into a therapy room at once, but now the therapists were actively working to address it rather than just assuring whoever cared enough to be in the room that the problem was other people, and not them.

Oh, also worth noting that therapy up to this point was still a LONG process, often expected to last years. Systemic Therapy made a push toward briefer, more effective interventions, creating modalities like Solution Focused Therapy, which combined Systemic and Behavioral principles to bring about real, lasting change within 4-6 months.

So, that’s the four cardinal philosophies I’ve sort-of-made-up as a labeling scheme to map all therapy onto. Now we get to the meat of the matter; how can just knowing about them actually help?

II. Case Study

“You have to help me,” Marge, 55, says during her first session. “It’s my husband. He’s become obsessed with model trains!”

Sidebar 1: An important thing to note is that the client said she needs help, but highlighted her husband as the focus of therapy. Some equivalent of “fix my spouse” (or “fix my kid”) is nearly as common, in my experience as “fix me,” and often times the spouses in question aren’t always in the room. So we work with what we have.

“I can see you’re worried about him,” I say. “What does ‘obsessed’ look like? Are you running out of money?”

“Well, no,” she admits. “We can afford it, but… every month he’ll order hundreds of dollars worth of new models and tracks, and after work he goes down to the basement. He spends hours down there, every day!”

I nod. “Yeah, it makes sense why that might be concerning. Is he skipping meals? Staying up all night?”

“No, no. He’s sleeping fine, he’s still eating… but it’s quick, you know, he’ll pop out of the basement for ten minutes, wolf down his food without looking at it, then go back to his trains for another six hours. That’s not normal, right?”

Sidebar 2: “ Normal,” along with “healthy,” is perhaps the most loaded word in therapy. Unless the client is insistent, or we’ve formed a strong therapeutic relationship, I try to avoid giving any kind of verdict on either, and instead use the therapist standby of answering a question with a question; in this case not ‘what is normal,’ but rather:

“What would you consider to be the ‘normal’ things he does do?”

“You mean like work?”

“Yeah, and beyond that. Is he still seeing his friends?”

“Yes, once in a while he’ll go out for some drinks with them.”

This is evidence that he’s not a shut-in. “Feel free to say it’s too personal for now, but just to check, does he still want sex?”

She blushes. “Not often, but, yes. Sometimes.”

“Okay. Does he talk about other things, or is it all trains all the time, now?”

“We barely talk at all, now, not like we used to.”

“What was the last conversation you had with him?”

“Oh, about the kids.”

“You have children?”

She smiles for the first time. “Yes, two. Both married, one with our first grandchild on the way.”

“Congratulations! And he’s still interested in them, and the grandchild?”

“Oh, yes. He put off our vacation so we’d be around the first few months.” Her smile is gone now. “Which normally I’d be in favor of too, but… there’s some sort of convention nearby around then that he’s still planning to go to.”

“A model train convention?” I guess.

“Yes, I’m telling you, he’s just…” She shakes her head, seemingly at a loss for words.

Sidebar 3: “Pathologizing” is the perception that any action or view that is unusual is automatically a sign of illness, despite no evident dysfunction or suffering. In decades past, previous versions of the Diagnostic and Statistics Manual labeled things like homosexuality a mental health illness due to a mentality that didn’t distinguish between “normal” and “healthy.” Newer versions of the DSM have eliminated most of those, and there’s a concerted effort among (good) psychologists and therapists to distinguish real pathology as something that causes direct suffering for the patient.

At this point, I might feel an urge to say “Okay, so… what exactly is the problem here? Just because your husband is spending hundreds of dollars and hours a month on model trains doesn’t mean he needs therapy. If it’s not affecting his sleep, or his appetite, or his work, or his social life… maybe he just likes trains, and that’s okay? It’s far from the worst hobby, and if it makes him happy, just let him like trains!”

I wouldn’t say this out loud, however, at least not in the first session, because even if I’ve become at least reasonably sure that the husband is okay, to say something like that would be dismissive of her experiences .

Regardless of what her husband is doing, she is clearly unhappy. And while she might think she can be the client but not the patient, the truth is, from a systemic lens, there is no distinction. The system she lives in, her marriage, is clearly dysfunctional for her in some way, as evidenced by how she’s suffering enough to come to a therapist. Perhaps her husband is too, in a non-obvious way that will be revealed through further questioning, but for now the focus would best be shifted to her.

There are a number of lenses through which to focus, however, and each might approach the problem in such different ways that they essentially become different problems .

  • A psychoanalytic therapist could delve into Marge’s past. Was her father distant with her, perhaps obsessed with his work or a hobby of his own? Did she have older siblings that left her out of their play? Was a childhood friend killed by a train? (Probably not that last one.)
  • A behaviorist could focus on the husband’s actions and develop strategies to reinforce or punish the ones she likes/dislikes. This would be pretty manipulative if the husband isn’t on-board, however, so instead the therapist might focus on ways to associate her husband’s hobby with positive emotions and experiences of her own.
  • An existentialist could help Marge delve into the emotional experiences she’s having, what she feels when she thinks of her husband in the basement or buying new models, and what needs she has that aren’t being met. The goal would be either to dissolve the problem entirely by reframing her expectations, or teaching her new tools to manage her mood and satisfy her emotional needs.
  • A systemic therapist could help by examining the overlapping systems she’s a part of; her marriage, her family, her social circles. Did she and her husband used to do more things together? What was their marriage like when the kids were still part of the household? How often does she spend time with her own friends or hobbies? Perhaps there are ways she could better communicate to her husband what her needs are so he can understand how she’s hurting, or examine what behaviors of hers might be reinforcing her husband’s without even realizing it.

While individual modalities might lack scientific backing, I believe the broader philosophies can each be suited to different types of problems. That still means that if a therapist only sees the world through one or two lenses, they might not be able to help their client as well as someone whose approach is the better fit.

Perhaps more importantly, each client can respond better to a different philosophy, even if they present with nearly identical problems. For some, just getting down to brass tacks and tackling the symptoms is their ideal, while for others, digging deep into their psyche is what they want and respond well to.

This is part of the reason why one of the major tenets of good therapy is “stay curious.” The more the therapist starts assuming they know what to expect from a client based on their presenting problem, no matter how often they’ve seen it before, the more likely they are to jump to conclusions about treatment that end up being a poor fit.

III. Modalities

A therapy modality is more specific than a philosophy; it’s not just a framework for what leads to dysfunction and how to correct it, but also a bundle of specific interventions and pathways, some more rigid than others, to lead the therapist and client from first session to last. Here’s just a few examples that I use regularly:

Cognitive Behavior Therapy is a mix of Existential and Behavioral. It focuses on the looping interactions between our thoughts, feelings, and behavior, and how they reinforce each other such that altering one can alter others. (Dialectic Behavioral Therapy leans even more into the Existential side, with extra attention on mindfulness and mood regulation.)

Solution-Focused Therapy is a mix of Systemic and Behavioral. It helps the client identify their strengths and resources in their social systems, as well as how those systems reinforce their behaviors or symptoms, or can be altered to better reinforce more desired ones.

Narrative Therapy is a mix of Systemic and Existential therapy. It asks the client to present the narrative of their life, identify the ways the story they tell themselves and its framing is influenced by the broader systems they’re a part of, then explores the way their narrative makes them feel while teaching techniques to better interface with those feelings.

And here’s a handy-dandy diagram that lists just a few of the different modalities, techniques, and interventions used in therapy. There are many more that exist, and there may be different ways of practicing each of these that bump them from one section of the diagram to an adjacent one, but I believe every modality and strategy of therapy can ultimately be placed somewhere on this image, depending on how much they focus on understanding the client’s past, interfacing with their thoughts and emotions, altering their behaviors, or adjustments to their environment/relationships.

(This is in no way a “complete” image, as there are dozens of different modalities and it would need to be massive to fit them all, but I figured it’s better to just publish with some listed and update it over time.)

IV. Change the Frame, Change the Problem

I like collecting lenses through which to view the world. Each is like a different kind of mental map that I can use to navigate the territory of reality, and just like different types of maps (some simplistic and cartoonish, others realistic and highly detailed) can be more or less useful for different purposes, even maps that I know are not literally correct can still have value.

Overall this post is an ur-map, my ur-map, of different maps I’ve learned about in the field of therapy. I don’t mean to present it as “the one true way to view therapy,” but I’ve found it very helpful, and I hope others can too. It’s also worth keeping in mind that it has many of the biases you’d expect from someone educated in an American college program that focused primarily on one particular philosophy.

Still, I think if more people were aware of the different lenses through which therapy can operate, they would better be able to navigate the sorts of problems that might lead them to a therapy office, maybe even help them find their way without going to one.

Next time you feel stuck in a particular way of thinking about your problems, a particular frame through which your problem seems insurmountable, try changing it. You might find it a lot more tractable than it seemed before.

Creating Boundaries

A large part of therapy for many people is learning how to create “healthy boundaries.” Whether adults or children, with friends or family, we often find ourselves having our desires ignored, our time undervalued, and sometimes even our bodies mistreated again and again, despite our attempts to express our preference against such things happening.

People who admit to having poor boundaries often look upon those that do not and wonder what the secret is. How do those people get treated with more respect? Why aren’t they mistreated as often?

There are plenty of potential answers in this space, from demeanor to status to power dynamics, but the most important thing to recognize is that when we talk about social boundaries, they do not exist as barriers that physically stop people from ever violating them.

All “having strong boundaries” means is that when someone pushes past a line you draw in the sand, or even just stumbles past it accidentally, you’re willing to push them back, gently or not. That’s it. Do that enough times, and voilà, you have boundaries.

Ideally, those pushes take the form of calmly stating your desires, and following through on consequences if they’re not respected. Unfortunately, if certain lines are crossed often enough, sometimes enforcing a boundary involves getting really, really mad, shouting and storming out and slamming the door, because anything less than that is just ignored. If the boundary crossed is a physical one, sometimes “pushing back” includes literal pushes.

And part of why some people have a harder time building and maintaining boundaries is that they have been conditioned to not ever do things like that, or the people violating their boundaries have power over them. Enforcing your boundaries is always an unpleasant thing to do, and sometimes it can be a dangerous thing to do.

But if you’re never willing to do any of those things, and you feel frustrated that people don’t seem to respect your desires or needs… this may be a large part of why.

Try not to push too hard at first, and don’t push thoughtlessly, but I’m here to tell you it’s okay to push back. The how and when might be complicated, but the will to protect yourself even if it upsets others others is the necessary first step.

Trauma

There’s a danger mode that society has been engaging in for years (decades/centuries/millenia?) that simply denied trauma. It was ignorant of trauma, or acted as if it didn’t exist, or verbally repudiated it. People were expected to tough out bad things that happened to them. Men especially were not allowed to express it, except (eventually) if it occurred as the result of war.

The pendulum has swung somewhat, and I hear rumblings of worry about whether we’re treating trauma too seriously. If we’re over-correcting and making things out to be more traumatic than they “really are,” and to what degree trauma is the result of people being told that something that happens to them is “traumatic” or is made a big deal of. This second failure mode concerning trauma is the worry that someone will fall off their bike, scrape their knee, and be taken to the hospital amidst parental tears and shock, thus cementing a lifelong fear of bikes or intolerance of pain.

While I think this second failure mode is probably true for things like how offended or outraged people get by things, I don’t think it’s in our sight-lines just yet for “actual trauma.” Over protective parents are a thing, always have been. If a kid falls off their bike, they are much more likely to cry if their parent freaks out. And yes, to some degree how society treats a thing will inform how people react to it. There are some people who are sexually molested or emotionally abused and essentially move on from it without ever telling anyone, or seeking professional help. This is particularly something you’ll hear from people who are older, and grew up before modern perspectives on trauma or awareness of abuse or rape was as prevalent as it is. There’s a fairly famous older man who got in some hot water for saying something like “Well, I was raped a number of times at the male boarding school I went to, and it sucked, but that was just a thing that happened. The older boys would do that often to the younger ones. It wasn’t the end of the world.”

People will look at accounts like this and be somewhat reinforced in believing that the response to traumatic events is moderately, or even largely, to blame for how traumatic it is.

But the thing to remember about trauma is that by its nature it is anti-correlated to reports and disclosures. You will hear more from the people who recovered from traumatic events or were not traumatized by bad events more often than you will those who were. This is axiomatic to what it even means to be traumatized by something vs not.

On top of the other points, like how no two situations are alike, and no two people are alike, and so making a general rule out of anecdotes is dangerous, it’s also hard to think of people who are actually traumatized by the response to a thing versus the thing itself. My experience is that Eddie Kaspbraks are really, really rare in real life, even in less stereotypical, absolute incarnations.

What I do run across instead, and quite often, are stereotypical incarnations of people who have spent years, if not decades, bottling up their trauma and appearing to all observers, even close observers, as if they’re okay, or as if the behaviors that they have that are harmful to themselves or others are just the result of who they are, and not what they’ve gone through, until something comes out and sheds light on dark machinery. Part of that just comes with the territory of my field of work, but even outside of it, that seems to be far more common than the inverse situation.

And when people who go through events others might call traumatizing, but who were not traumatized by it by some combination of factors that are so far unknown, see such people, I worry that their conclusion will be that this is proof that trauma is the result of low willpower or resilience or “grit” or whatever.

The pendulum may well be swinging toward society being too sensitive to traumatic fears and causing more harm than it’s preventing in highlighting bad experiences as “traumatic.” But so far I don’t know that I’ve seen enough evidence to conclude that for sure, and I hope we get better metrics and tools to determine if that’s in fact what’s happening before we start encouraging a narrative that might make those who suffer from trauma feel in some way as if it’s “all in their head,” like society used to.