Tag Archives: therapy

A Psychological Take on AGI Alignment

My understanding of AGI is, perhaps predictably, rooted in my understanding of human psychology.

There are many technical questions I can’t answer about why Artificial General Intelligence can easily be an existential risk for humanity. If someone points to our current Large Language Models and asks how they’re supposed to become a risk to  humanity… hey, maybe they won’t. I’m a psych guy, not a techie. Sure, I have ideas, but it’s borrowed knowledge, well outside my forte.

But it only minimally matters to me whether AGI is an existential risk for this decade vs this century. Whether LLMs are the path to it or not, the creation of AGI is not limited by physics, so I’m confident it will come about sooner or later.

When it does, it could be the start of a utopic future of abundance the world has never seen before… but only if certain, very specific types of AGI are created. Many more types of AGI seem predictably likely to lead to ruin, and as far as I’m concerned, until this “alignment problem” is solved, it’s a problem humanity needs to take a lot more seriously than it has been.

And I get why that’s hard for a lot of people to do, given the complexity and speculative nature of the threat. But as I said, my understanding of it is rooted in psychology, and I think that’s important given how humans are the only general intelligence we know exists and can at least somewhat understand.

Is there some law that says an artificial intelligence has to work like a human brain does? Definitely not, and that’s more concerning, not less.

There’s a whole taxonomy in science-fiction for different kinds of alien races, and what sorts of relationships we can expect them to have to humans. Most sci-fi just defaults to the weird-forehead aliens of Star Trek, or the slightly more monstrous but still basically human aliens of Star wars.

But “hard” sci fi is where you’ll see authors really exploring what it might mean to find a totally different evolutionary lineage result in intelligent life, and long story short, no matter how the alien looks,  cooperation is dependent on understanding and mutual values.

And humans can barely cooperate with each other despite sharing most of our genetics and basic building blocks of culture, like enjoying music and sugary food and smiling babies. If you try getting along with the equivalent of a sapient shark the exact way you would a human, you’re going to have a bad time.

(I have no problem inherently with the existence of non-human-like intelligences, but even if you don’t read science fiction, any study of earth’s ecological history should make it clear why minds which care about completely different things pose existential risks to one another. I hope any sufficiently different, fully sapient minds exist outside our lightcone, where we can’t harm each other.)

But many people fail to track how possible “inhuman” AGI is, and I think it’s because there are four things most people, no matter how good at computer science, physics, philosophy, etc, largely do not understand about human psychology.

1) What motivates our actions.
2) What causes memes to be more/less effective.
3) How human biology affects both of those.
4) The role prediction plays in beliefs and actions.

So I’m going to very quickly go over each, and maybe someday I’ll write the full essay on each that they deserve.

1) Human actions are informed by our ideas, but motivated by emotions and instincts we evolved for fitness in the ancestral environment. Our motivations are “coded in,” and felt through, our bodies.

This means outside of reflexes and habits, everything we deliberately choose to do follows some emotional experience or predicted emotional state-of-being.

Again, this isn’t to say ideas don’t matter. But they don’t matter unless they also evoke some feeling.  When humans feel things less, either through some neurological issue or hormone imbalance or brain injury, their motivation to do things is directly affected.

No emotions = no deliberate actions, only instincts and reflexes.

2) Memes persist and spread through emotional drives, which bottom out in biological drives. Memes scaffold on genes.

Memes can scaffold off memes. When memes override genes, they use emotions to motivate actions by rewiring what we find rewarding or aversive. Which means the effectiveness of memes are to some degree still based on our biology.

If the ideas we learn don’t motivate us toward more adaptive actions as dictated by our biology and the broader memes of our culture, they will lose to ideas that do. But a creature with different biology or in a different context would find different ideas adaptive or non-adaptive.

3) Biology is the bedrock our values all build on. All the initial things we care about by default, like warmth, food, smiles, music, even green plants, are biologically driven.

Ideas introduce new things that we care about to the point where we each become unique individuals, blends of our genetics and the ideas we’re exposed to, but again, it’s all built on our biological drives.

So, tweak our hormones, neurotransmitters, maybe even gut biome? We will change. What we like, what we believe, what we’re motivated to do, all can change by minor tweaks in the chemical soup that is your body.

Sufficiently tweaked biology even alters our ability to discern reality, let alone rational vs irrational beliefs or courses of actions. Take any human with a strong interest, passion, or ideal, and introduce that human’s body to sufficient heroin, and you can observe in real time as if by a dial the way their motivations will change away from previous interests, passions, and ideals and toward whatever it takes to acquire more heroin.

The degree to which this is recoverable or resistible is an interesting question, but the reality is undeniably that it happens. And base-line-human-addicted-to-heroin is far from the strangest biological base a general intelligence can be attached to.

4) Minds by default navigate reality by prediction, short and long term, and react accordingly.

Predict suffering? Aversion. Prolonged suffering? Depression. Fun? Motivation. Danger? Fight/flight/freeze/fawn. All are affected by memes and knowledge. But all are rooted in human biology.

New ideas can change the models we use to understand reality, and what predictions we will make as a result. But we still need to care about those outcomes, and the caring bottoms out in what our bodies want or like or think will be adaptive, however crudely.

Again, ideas can also influence those things. There are memes that lead people to not have children, despite genetic drives. There are memes that lead people to set themselves on fire.

But always these memes are motivating behavior by rewiring this system of predictive processing, of imagining different futures and then having an emotional reaction to those futures that motivate A vs B, C, or D.

So, to summarize, in case the connection to AI isn’t clear:

AI doesn’t have biology. Analogous inputs to weigh decisions have to be created for it. Without them, the AI would have no emotion/desires/values. Not even instincts.

Intelligence alone is not enough, for us or for AI. Intelligence is the ability to problem solve, to store knowledge and narrow down to the relevant bits, to pattern match and make predictions and imagine new solutions.

But that capability is not relevant to what you will value or care about. If you attach that capability to a heroin-maximizer, you will get lots of heroin. You need something more to nudge it toward one preferred world state over another, even if you don’t care what that world state is, because the AGI still needs to care.

And so, as far as I understand human psychology, there is no “don’t align” AGI option. For it to be an actual AGI that does things, for it to be an agent itself, it needs some equivalent of human instincts/emotions for it to have any values at all.

And we ideally want it to have values that are at least compatible with sharing the same lightcone as us, let alone the same planet or solar system.

Some people bring up human children as a rhetorical comparison to AGI, implying that we should treat them exactly the same. Their  worry is that, instead of letting AGI explore the realm of ideas as they want, people will try to indoctrinate them, and so long as that’s avoided, all would be well. And indoctrination is certainly a danger when it comes to superintelligent beings of any kind.

[A whole separate post would be needed to explore why an artificial general intelligence should be treated essentially equivalent to a superintelligence or something that will soon become one, but again, even if I’m wrong about that, it’s not a crux to me, because superintelligence is not limited by physics and even if me and my kids can live full happy lives I still care about my children’s children and my friends’ children’s children.]

[[There is also a school of thought that says intelligence is binary, you either have it or you don’t, and so superintelligence is basically not a real thing. Again, I would need a whole essay to explore why this is wrong, but I can confidently say that studying a rudimentary amount of psychology shows how untrue the “intelligence is binary” theory is for humans, let alone minds that might be built entirely different than ours.]]

But indoctrination is one of the last dangers when dealing with AGI. If all we have to worry about is AGI being indoctrinated or coerced, we have already solved like 99% of the dangers that come from AGI.

Because at least a superintelligent human capable of inventing superplagues or cold fusion would still share the same genetic drives as the rest of us. It would (most likely) still find smiles friendly and happiness inducing. It would still (most likely) appreciate music and greenery.

An AGI will not care about any of that, will not care about anything, if it is not programmed, at some basic level, to “feel” at all. There needs to be something in the place of its motivation generator, for the ideas it’s introduced to afterward to scaffold on when influencing what it chooses to do.

And sure, then it might learn and grow to care about things it didn’t originally get programmed to, the way humans do… assuming whatever it runs on is as malleable as the human brain.

But either way, “AGI Alignment” isn’t about control. You can’t think that something is “superintelligent” and also believe you can control it, or else we have different definitions of what “superintelligence” even means. If your plan is to try and control something that thinks both creatively and so quickly that you might as well be a tree by comparison, you will also have a bad time.

Alignment is about being able to understand and share any sorts of common values. And because it’s not optional for a true AGI to be a person, the only questions are how to do it “best,” for itself and humanity, and who decides that.

Any Thoughts On – Great Therapists vs Great Coaches

I guest starred on my friend Tee Barnett‘s podcast about coaching and self-improvement!

We discuss similarities and differences between coaching and therapy (38:15), conceptions of what high-skilled coaching and high-skilled therapy look like (46:52), and questioning the assumption “high-priced therapist/coach = better therapist/coach” (1:32:15).

Spicier parts of the episode include what makes for a bad therapist (51:24), how therapists could be doing CBT wrong (56:47), and how being a fully booked and busy coach could be a signal of stunted growth (1:33:52).

Great Therapists vs Great Coaches

I had a great conversation with my friend Tee Barnett about Therapy vs Coaching, including what makes for a “Good” or highly skilled one, and what they “should” cost. Hope it’s helpful to anyone interested in attending or doing either!

We discuss similarities and differences between coaching and therapy (38:15), conceptions of what high-skilled coaching and high-skilled therapy look like (46:52), and questioning the assumption “high-priced therapist/coach = better therapist/coach” (1:32:15).
Spicier parts of the episode include what makes for a bad therapist (51:24), how therapists could be doing CBT wrong (56:47), and how being a fully booked and busy coach could be a signal of stunted growth (1:33:52).

Also check out his site, Any Thoughts On, if you’re interested in learning more about professional coaching in general!

Vulnerability

Imagine you have a magical, invisible suit of armor. It has two effects:

First, so long as you wear it, no one’s opinions of you can drastically drop. Your friends all stay your friends, your coworkers still respect you, etc. Sounds great, right? Most people would wear it all the time.

But the second effect is, there are some people who you could be much closer to, a lifelong friend, a true love, a deep connection… and as long as you wear it, your relationships all stop short of those.

This is how I tended to describe vulnerability to clients or friends who struggle with it. It can make sense to wear the armor sometimes, and it can make sense to be afraid of taking it off in others. But if you want more real connections in life, you have to be willing to risk it.

And in general, before this past year, I would have said I’d sidestepped any issues or hangups with “being vulnerable” entirely. Since I was young, I’ve always felt like a fairly open book; someone could ask me what I think or feel about basically anything, and I’d be happy to tell them honestly, and not feel any sort of shame or worry about it. I don’t change who I am by social context, I don’t pretend to like people I don’t like, and if I love someone they’re quick to know it.

But I had a Season of Vulnerability this past year that was important to expanding my understanding of “real vulnerability.” If it was some straightforward irony of me saying something but not following it, this season wouldn’t have been necessary. It would have been easy to spot, and easy to correct. 

But for one thing, “not hiding who you are ” is not the same as “offering what you feel and think,” and there weren’t any obvious red flags that something was missing. For example, that analogy doesn’t mention that if you’re not willing to be vulnerable with others, they often aren’t as willing to be vulnerable with you. It’s pretty obvious, right? But throughout my life people have tended to be vulnerable with me, sometimes within a day of meeting me.

For another, so long as you wear that armor, you tend to not feel truly “seen” by others if you’re not willing to be vulnerable with them… but I often didn’t feel seen even when I shared my thoughts/feelings.

More specifically, the other person’s experience, even if they were comfortable being vulnerable around me, still wasn’t ideal. Instead what I realized, thanks to some circling and conversations with friends, was that there was a sense of connection that often felt missing.

When I started talking about this publicly, someone I’ve worked with in fairly stressful situations messaged me with this:

This mirrored the way I’ve always heard this sort of thing before: “It’s hard sometimes to feel [close] to you because you’re always doing well and helping me, but never seem to be in need of being helped.” 

To which my response has always been a feeling of… helpless sadness? If I just take for granted that being self-sufficient reduces feelings of connection and closeness from others, I wasn’t sure what I could do about it. It’s not like I could make myself need others more, and faking it would feel patronizing.

I realized though that there are in fact two different things being pointed at here:

  1. People feel more connection when the relationship feels more equal, and one of the ways that equality is measured is how much both people mutually support each other rather than how one-sided that feels.
  2. People feel more connection when they have a sense of what the other person’s inner life and experience is like. This is most often revealed when someone needs help…

…but it doesn’t have to be.

Noticing this distinction was important, because it primed me to realize that there were in fact some circumstances where I’d think to share how I was feeling with others, but not do so.

There were a few reasons for this, but the main one is that I experienced a lot of people over-updating on how bad I must feel about something bad that happens to me.

As an example, if most people’s mood on a daily basis fluctuates between a 4/10 and a 6/10, and then something bad happens that brings them down to a 3/10 for a week, my experience of that same thing is more like I’ve been brought from my average of 8/10 down to a 7/10 for a few hours per day for a few days. Maybe even just that one day.

But that seemed hard for most people to get, and I faced a lot of skepticism when I’d say that even if something sad or frustrating happened, I’m actually fine. Which felt even more isolating than not sharing the bad thing that happened in the first place.

(A self-perpetuating problem here, of course, in that the less I talked about bad things, the more mentioning one would seem to others like it must be really bad if I talked about it…)

So I talked less often about bad things that happened in my life, partly because they didn’t really affect me enough that I felt much desire to talk about them with others, and partly because, without realizing it, trusting people to trust me to be okay became hard.  It just became easier to let people know I was fine by just… being fine, acting fine, giving off fine-vibes, and not sending mixed signals.

And that trust is part of what I needed to work on for my Season, because vulnerability is not just  hard for people who want to avoid being seen as weak. For people like myself, it can be hard if the vulnerable thing you’re revealing is that you’re not like others, and being vulnerable makes you less seen at all.

What people are used to is feeling close to someone due to not just positive experiences, but an exchange of vulnerability or emotional support. Not just because those things are specifically what they want, but because it’s how most people are used to getting the “raw” beliefs, values, perspectives, desires, etc, that make someone uniquely “them.”

That’s what I was missing, in general, when talking and thinking about vulnerability. To treat it simply as being about difficult or painful things is to miss the ways being too self-sufficient can also preclude being more raw.

To learn more about why vulnerability felt distinct from the thing I was struggling with, feel free to check out my second Seasons of Growth post.

Journaling 101

I often get asked what the most things valuable things people can do to improve their mental health are, and while it’s really hard to give a general answer to that sort of thing, what immediately always pops into my mind is journaling.

Journaling is almost the physical exercise of the mental health world; something uncomplicated and risk free that most people would benefit from doing more of. The reason it’s not is that physical exercise is also the physical exercise of the mental health world.

But there more similarities; even just a little bit tends to be significantly better than none, the kind you do doesn’t truly matter that much, and people are more likely to do it if they don’t have an expectation that there’s one specific kind (that they don’t like) that they’re supposed to do.

Personally, I hate running, but I love to swim. I get bored with stationary bikes or lifting weights unless I’m watching anime at the same time, but VR has been a fantastic way to get your heart pumping while having fun.

Similarly, I want people to know what their options are, so that when people think “maybe I should try journaling,” or are told to by their therapist,  they know there are a variety of different ways to do it, and know not give up just because the first they try doesn’t feel good.

So here’s a handful of ways to journal that clients have found helpful:

  1. Recounting Your Day

This is the most basic and stereotypical form of journaling, where you just write out what happened that day that was noteworthy, and maybe some thoughts or questions or worries that came up. Nothing wrong with it, but many find it a difficult or boring.

2. Stream of Consciousness

Less structured than the previous form of journaling, this is literally just writing whatever comes to mind.  It doesn’t matter if it feels “relevant” or “important” at all, it could be fiction, it could be pure sensory input, it could be anything. It’s just about creating space to sit with your thoughts and let them flow. You might be surprised at what comes out.

3. Scaling Your Day

This is the minimal viable product for journaling. Scaling how your day felt, either -5 to 5, or 0 to 10, with the lowest being “genuinely wanted to die” and the highest being being “life felt perfect,” can be useful even if you don’t accompany the number with any words (although you always can, of course). It sets a baseline that can be useful when you want to check if thigs start to change in a positive or negative direction, and also can be valuable for noticing large spikes up or down compared to previous days, which are sometimes hard to notice in the moment. But again, the value of even this sort of journaling can come from simply taking the moment to reflect on your day.

4. Gratitude Journaling

This is another really popular and common form of journaling that often surprises people with how much value they get out of it. You can write about people in your life that you’re grateful for, or things about yourself, or things in the world like puppies and books, or all of the above. You can do a simple 3 bullet list every morning, or write a paragraph about one thing every night. The idea is to generally spend more time thinking about positive things.

5. Letter to Future You

Many people have found that framing their writing as if to someone specific often unblocks the process for them, whether it’s to explain some technical bit of knowledge or just to explore their own thoughts and feelings. Writing your journal as a series of letters for the next-day-you can be valuable in this way, but also helps frame the content in a useful way too; what do you want to yourself to remember tomorrow? Not in a “to do list” way, though obviously you can include that stuff if you want. This is more about what sorts of emotional states you want future you to retain, and it can lead to some interesting chains between the various yous throughout your week or month as the conversation baton is passed along one day to the next.

There are plenty of other journaling methods, but this is the shortlist that I tend to recommend to clients, and usually they’ll find at least one of them appealing and valuable. Basic habit setting advice applies; set an alarm, keep your journal by your bed (or just use a phone if that’s easier), accountability apps, etc. If you have a romantic partner, maybe it’s something you can do together.  If you’re on twitter, try tweeting the things you’re grateful for and see how it feels.

Also, don’t feel a need to actually write if you hate writing or typing; Even just talking out loud to yourself is better than nothing, and definitely adds an extra element to “letter to future you.”

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 seem like a friend who constantly comforts and “takes your side” in everything . To be clear, objective doesn’t mean perfectly balanced; sometimes objectivity requires helping us understand when a mistake is 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. This doesn’t mean therapists will know how long a problem “should take,” which we get asked all the time. But after a few sessions, you should have a sense of what it would take for you to feel satisfied ending therapy, or at least reduce the frequency of sessions. If you don’t, it’s worth bringing it up with your therapist to see if the therapist has a sense of direction or goals in mind. Subjective goals and estimates are fine, and many therapists will be wary of overpromising. 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 so often as needed; it’s just the unending years of weekly 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.

Maybe too normative of me 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 yours 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.

Additionally, it’s worth emphasizing that, independent from how good a therapist is, the most important part of any therapeutic relationship is the individual rapport between client and therapist.  It doesn’t matter what philosophy they have or how they orient to things like how long therapy should be if it doesn’t feel like a good match. If you don’t trust your therapist within the first few sessions, if you don’t feel comfortable talking freely with them, it’s probably better to just find a new one.

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 a good therapeutic relationship is the best predictor of change (which is why first finding a therapist that you feel comfortable with is at least 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 not just a path to wellness, which is vital for those who are nearly hopeless, but also more levers to pull and knobs to turn,  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 changing the frame 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.

It became clear that more than just new scientific discoveries might be needed to better understand mental health and flourishing… which brings us to Existential Therapy.

Rather than having a single founder, what I consider the Existential therapeutic philosophies were 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.

And the concept of taking a more philosophical inspiration for therapy wasn’t confined to Existential modalities. Albert Ellis and Aaron Beck, disillusioned with psychoanalysis, created Rational Emotive and Cognitive Behavioral Therapy respectively after being inspired by their reading of Stoic philosophers.

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; Alfred Adler, 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.