{"id":34361,"date":"2017-03-30T06:00:49","date_gmt":"2017-03-30T13:00:49","guid":{"rendered":"http:\/\/www.goodtherapy.org\/blog\/?p=34361"},"modified":"2017-03-23T10:02:58","modified_gmt":"2017-03-23T17:02:58","slug":"therapys-goal-finding-pathology-or-accepting-complexity","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/therapys-goal-finding-pathology-or-accepting-complexity-0330174","title":{"rendered":"Therapy\u00e2\u20ac\u2122s Goal: Finding Pathology or Accepting Complexity?"},"content":{"rendered":"

\"DoubleLabeling pathology<\/a> in another person is easy. One teacher of mine said it\u00e2\u20ac\u2122s like \u00e2\u20ac\u0153shooting fish in a barrel.\u00e2\u20ac\u009d Think of any person you know and, unless you\u00e2\u20ac\u2122ve totally idealized them, I bet you can find some psychological diagnostic label to pin on them. \u00e2\u20ac\u0153So neurotic!\u00e2\u20ac\u009d \u00e2\u20ac\u0153So hysterical!\u00e2\u20ac\u009d \u00e2\u20ac\u0153So narcissistic!\u00e2\u20ac\u009d We all have the ability to spot apparent pathology. But we all, therapists included, sometimes have a much more difficult time recognizing health\u00e2\u20ac\u201dthe healthy strivings of others and<\/em> of ourselves.<\/p>\n

So why is so much mental health education, from graduate programs to popular blog posts<\/a>, focused on helping people identify and label (aka diagnose) pathology? What problematic dynamics are evoked when the therapist and others function only as pathology detectors? How can we reorient ourselves toward detecting human complexity, the complex intertwining of \u00e2\u20ac\u0153health\u00e2\u20ac\u009d and \u00e2\u20ac\u0153pathology\u00e2\u20ac\u009d within ourselves and each other?<\/p>\n

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Why Is It Useful to Be Sensitive to Pathology?<\/h2>\n

Imagine if you went to your car mechanic because something is wrong\u00e2\u20ac\u201dyour car would not accelerate past 25 mph. Imagine the mechanic takes a thorough look at your car and says, \u00e2\u20ac\u0153Well, I can\u00e2\u20ac\u2122t see anything wrong. I think your car is fine.\u00e2\u20ac\u009d You might be more than a little concerned about your difference of opinion with the mechanic, and you\u00e2\u20ac\u2122d probably look for a second opinion.<\/p>\n

The same is true with therapists. Some emotional problems show up in big, visible ways\u00e2\u20ac\u201da depression<\/a> that makes it hard to get out of bed, for example, or panic attacks<\/a>. However, some mental health conditions and\u00e2\u20ac\u201dmore importantly\u00e2\u20ac\u201dthe underlying emotional processes that contribute to them are quite subtle and difficult to detect. Without thorough and nuanced training in detecting the manifestations and drivers of people\u00e2\u20ac\u2122s issues, therapists are at risk of looking a suffering person in the eye and saying, \u00e2\u20ac\u0153You seem fine to me.\u00e2\u20ac\u009d For this reason, we need a refined understanding of all the parts in the engine of the human mind<\/a>, and we need to know how a person looks when some part of that engine is malfunctioning.<\/p>\n

As important as it is to be able to see and understand a person\u00e2\u20ac\u2122s issues, the therapeutic relationship<\/a> is deeply compromised when the person\u00e2\u20ac\u2122s issues are all <\/em>we can see.<\/p>\n

When All We See Is \u00e2\u20ac\u0153Resistance\u00e2\u20ac\u009d<\/h2>\n

Realistically, some people come to therapy in a near-total state of resistance:<\/p>\n

\u00e2\u20ac\u0153I didn\u00e2\u20ac\u2122t want to come today.\u00e2\u20ac\u009d<\/p>\n

\u00e2\u20ac\u0153I\u00e2\u20ac\u2122m only here because my partner said I need to be here.\u00e2\u20ac\u009d<\/p>\n

\u00e2\u20ac\u0153Does therapy even work?\u00e2\u20ac\u009d<\/p>\n

It can be hard to imagine how progress can be made in the face of attitudes like these. It seems like \u00e2\u20ac\u0153pathologies\u00e2\u20ac\u009d like defiance, passive compliance and hopelessness<\/a> have totally taken over the people quoted above. It\u00e2\u20ac\u2122s hard to find any overtly \u00e2\u20ac\u0153healthy\u00e2\u20ac\u009d dimension of their comments.<\/p>\n

As a therapist, I encounter statements like these with great regularity, and I\u00e2\u20ac\u2122ve seen plenty of instances of \u00e2\u20ac\u0153resistance\u00e2\u20ac\u009d and \u00e2\u20ac\u0153pathology\u00e2\u20ac\u009d that are even more bold and provocative. It is incredibly easy to hear these comments and become hopeless\u00e2\u20ac\u201dif all we see is resistance, we may begin to doubt whether a healing-oriented part of the person even exists for us to build an alliance with.<\/p>\n

In moments like this, we forget that, though the person\u00e2\u20ac\u2122s words are defiant, passive, hopeless, or whatever else, they still arrived for their session. Not only are they present for the session despite this resistance, they are making an effort to be honest about how they feel. When we relate only to a person\u00e2\u20ac\u2122s resistance and \u00e2\u20ac\u0153pathology,\u00e2\u20ac\u009d we forget that their sharing <\/em>of their resistance and sharing<\/em> of their \u00e2\u20ac\u0153pathology\u00e2\u20ac\u009d is a vulnerable attempt at forming an alliance with us. When we relate only to the resistance described by their words and not to their efforts to reach out through sharing, we miss an important opportunity to connect with the healing-oriented forces buried under the surface behaviors. When all we see is \u00e2\u20ac\u0153resistance\u00e2\u20ac\u009d and \u00e2\u20ac\u0153pathology,\u00e2\u20ac\u009d we miss out on the full complexity of the person we are trying to get to know.<\/p>\n

Consequences of Seeing Only Pathology<\/h2>\n

When we fail to recognize and acknowledge the \u00e2\u20ac\u0153resistant\u00e2\u20ac\u009d person\u00e2\u20ac\u2122s profound efforts to reach out to us by sharing their resistance<\/em> openly, certain problems can plague the therapy alliance.<\/p>\n

The person will not feel heard.<\/strong> Generally speaking, we can sense when someone is \u00e2\u20ac\u0153pigeonholing\u00e2\u20ac\u009d us or seeing us in a one-dimensional way, and we tend not to like that. Conversely, we tend to appreciate it when people have a complex understanding of us, with honesty about our inner \u00e2\u20ac\u0153bad\u00e2\u20ac\u009d and \u00e2\u20ac\u0153good\u00e2\u20ac\u009d and \u00e2\u20ac\u0153mixed\u00e2\u20ac\u009d-ness.<\/p>\n

This ability to see and embrace our complexity is perhaps one of the great challenges of growth in therapy and elsewhere. Every day and every therapy session reveals new truths about us, presenting anew the challenge, \u00e2\u20ac\u0153Can I accept this part of me?\u00e2\u20ac\u009d<\/span><\/p>\n

When we as therapists relate only to the \u00e2\u20ac\u0153pathology\u00e2\u20ac\u009d and \u00e2\u20ac\u0153resistance\u00e2\u20ac\u009d people show us, rather than convey our appreciation for the fact they are showing up to willfully tell us about it, they may feel, and rightfully so, only one part of them is being heard. When we fail to acknowledge the healthy efforts that emerge alongside or are veiled by their \u00e2\u20ac\u0153resistance,\u00e2\u20ac\u009d we relate only to their \u00e2\u20ac\u0153badness,\u00e2\u20ac\u009d which can have a severely negative impact on our alliance and lead people to feel more hopeless. Sadly, in cases like these, people often blame themselves for their therapist\u00e2\u20ac\u2122s error: \u00e2\u20ac\u0153It\u00e2\u20ac\u2122s my fault the therapy didn\u00e2\u20ac\u2122t succeed. I\u00e2\u20ac\u2122m just too<\/em> resistant!\u00e2\u20ac\u009d<\/p>\n

The person sitting across from us is already good at criticizing themselves.<\/strong> An expert ability to see and criticize our own foibles is part of what brings many of us to therapy in the first place. I have noticed when therapists relate only to a person\u00e2\u20ac\u2122s pathology, one common response is for the person in therapy to join in with the therapist, criticizing their thoughts, feelings, and behaviors. This may look like helping a person \u00e2\u20ac\u0153turn against their defenses\u00e2\u20ac\u009d or helping them to \u00e2\u20ac\u0153see their resistance,\u00e2\u20ac\u009d but so often it is the establishment of an alliance built around change via criticism, which never seems to yield the desired therapeutic result.<\/p>\n

The person may try to change, but not to please themselves.<\/strong> People in therapy tend to respond to the therapist\u00e2\u20ac\u2122s tendency to notice only their pathology by trying to change. In these instances, they tend not to be changing for themselves or changing in directions they desire for their own well-being; instead, they tend to change in the direction they believe their therapists would prefer with the hope of no longer being criticized or related to as \u00e2\u20ac\u0153bad.\u00e2\u20ac\u009d This can be a reenactment of problematic attachments from the person\u00e2\u20ac\u2122s past.<\/p>\n

The Therapist\u00e2\u20ac\u2122s \u00e2\u20ac\u0153Pathology\u00e2\u20ac\u009d<\/h2>\n

Your therapist\u00e2\u20ac\u2122s difficulty seeing your complexity, the ways your healthy efforts coexist and intertwine with your struggles, is a reflection of their difficulties seeing and accepting their own complexity. Remember, we tend to treat others the way we treat ourselves, and to see others through the lenses we see ourselves through; as a result, the tendency of a therapist to pigeonhole a person as \u00e2\u20ac\u0153pathological\u00e2\u20ac\u009d suggests the therapist may tend to devalue themselves that same way.<\/p>\n

I can only accept the complexity of the people I help to the degree I can accept my own complexity. As therapists, and as people in general, whenever we meet a new person or a new part of ourselves we are called upon to face deeper and deeper levels of the complexity that is humanity. In that moment when we meet a new person, a new truth, will we accept it in all its complexity or will we reduce it to \u00e2\u20ac\u0153pathology\u00e2\u20ac\u009d?<\/p>\n

Can We Accept the Complex Beings We Are?<\/h2>\n

So how can we see each other as complex people? How can we manage to hold both our health and our destructiveness in mind simultaneously so we have the most complete information about ourselves to work with? How can we gain an appreciation for the complex intertwining of our efforts to communicate and our efforts to wall off, such that our moment of greatest \u00e2\u20ac\u0153resistance\u00e2\u20ac\u009d may actually be our most profound effort to reach out? Can we accept our \u00e2\u20ac\u0153resistance\u00e2\u20ac\u009d as simply the most health we can muster at the moment?<\/p>\n

This ability to see and embrace our complexity is perhaps one of the great challenges of growth in therapy and elsewhere. Every day and every therapy session reveals new truths about us, presenting anew the challenge, \u00e2\u20ac\u0153Can I accept this part of me?\u00e2\u20ac\u009d So often in therapy, when we discover something previously unknown about ourselves, we are tempted to reject and pathologize it. It is even tempting to pathologize and reject our tendencies to pathologize and reject ourselves! The human mind is incredibly adept at making an enemy of itself.<\/p>\n

So can we accept that? Can we accept the conflictedness about self-acceptance that is part of our humanity at this moment? Can we initiate the journey of acceptance by loving and embracing the pathologizer and rejecter inside right now? That tendency must have been important to learn; otherwise, we would not have learned it. What if the goal in psychotherapy<\/a> is not about finding health or finding pathology, but about attempting to embrace all of ourselves?<\/p>\n","protected":false},"excerpt":{"rendered":"

We are all susceptible to pathologizing others and ourselves\u00e2\u20ac\u201dtherapists included. This can overshadow therapy’s utmost purpose: embracing human complexity.<\/p>\n","protected":false},"author":2977,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_crdt_document":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[542,626,628],"tags":[579,685,49,644],"class_list":["post-34361","post","type-post","status-publish","format-standard","hentry","category-featured-articles","category-for-therapists-by-therapist","category-general","tag-for-therapists","tag-pathologizing","tag-considering-psychotherapy","tag-therapeutic-relationship"],"acf":{"author_show":false,"author_name":"","author_role":"","author_avatar":null,"author_profile_url":""},"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/34361","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/2977"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=34361"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/34361\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=34361"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=34361"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=34361"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}