Is psychotherapy purely a medical treatment warranted only for treating specific mental health issues? Can psychotherapy also be used to address the multitude of emotional, cognitive, and physiological ways in which people suffer, ways that do not meet the diagnostic criteria for categorically based syndromes? Additionally, is psychotherapy of any use to those seeking self-growth, wisdom, clarity, compassion, self-esteem, and consciousness?
If you’re a psychotherapist trained in the psychodynamic or humanistic schools of thought, the questions above may seem absurd and the answers blatantly obvious. If you’ve been heavily influenced by the medical and psychopharmacological models, you’re probably not going to like my answer.
The debate, however hidden it may seem, lurks in a fundamental difference between those psychotherapists who see the value of psychotherapy as a means of self-exploration (in addition to treating syndromes) and those practitioners who subscribe solely to the medical model and, I’m guessing, have never experienced depth psychotherapy. The issue arose in response to a recent GoodTherapy.org poll designed to measure whether therapists believe prelicensed therapists should undergo their own therapy as a licensure requirement. In this poll of 6,760 respondents, 69.30% of respondents were in favor of this requirement, 23.82% were against, and 6.88% were undecided.
As part of the poll, respondents were able to elaborate on their viewpoints by leaving comments. Roughly a dozen of the respondents who were against prelicensed therapists being required to attend therapy argued that, in the same way it makes no sense to require brain surgeons to undergo their own brain surgery to become better surgeons, it also makes no sense for therapists to undergo their own therapy to become better therapists. For example, a counseling psychologist from Melbourne, Australia wrote, “We don’t require doctors to provide evidence that they’ve had intensive medical treatment.” Essentially, members of this group were in agreement that participating in therapy must be warranted by illness.
In this post, my aim is to address both the “apples to oranges” logic of comparing physicians to psychotherapists and to explain why psychotherapy is warranted for a wide range of issues outside of mental health and diagnostic categories. Let’s start with the former.
I agree that the idea of requiring brain surgeons to undergo their own brain surgery, based on the assumption that the experience of one’s own brain surgery makes for a better brain surgeon, is absurdly humorous. Imagine how scarred and bruised some of the nation’s best surgeons would be as a result, and try to wrap your mind around how these hypothetical patient-doctors would actually learn anything while under anesthesia. Beyond being silly, it’s an error to make an analogy between therapy and brain surgery. Although a good bedside manner is always appreciated, successful brain surgery does not necessitate the presence of a healthy doctor-patient relationship—in fact, surgery can and often is performed without the surgeon and patient ever meeting each other.
Successful therapy, unlike brain surgery, requires a healthy and attuned client-therapist relationship, and a therapist who is technically skilled, emotionally intelligent, and adequately self-aware. Why? Psychotherapy does not use a scalpel and precise incisions to cut body parts out. Rather, the main tool of change in therapy is the relationship between the therapist and person in therapy, and, given the landmines which present themselves within emotionally intimate relationships, this inter-psychic realm cannot be effectively navigated by therapists who have not identified their own projections and countertransference patterns or who lack the emotional awareness to sense when their own baggage is interfering with the therapy process. I’m sure there are a number of roads leading toward an examined and emotionally intelligent life, but in my experience, therapy is a very effective process for getting to know oneself and becoming conscious of one’s own stuff, regardless of what we call that stuff: baggage, ego states, complexes, scripts, parts, burdens, exiled aspects, wounds, defense mechanisms, etc.
Unlike medicine, psychotherapy is not intended solely for dealing with medical-model disorders; psychotherapy also helps people recognize more subtle personality issues and can be used for personal growth, self-actualization, and improved relationships. Frankly, I am frightened by the number of practitioners who commented to the poll expressing a firmly held belief that therapy is meant only for treating mental health issues. I can only assume that these respondents are not psychotherapists and/or have been fully steeped in the psychiatric and medical-model approach. Perhaps these are clinicians who have never sat in the seat of a person in therapy or did not experience emotional growth as a result of their therapy. Whatever the origin of the viewpoint that therapy must be warranted by illness may be, it’s clear to me that it is held by a very small minority of respondents. My hope is that members of this group are open to considering an alternative viewpoint and are willing to try different forms of psychotherapy. As therapists, we should all be willing to practice what we preach.
© Copyright 2011 by Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.