{"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\u2019s Goal: Finding Pathology or Accepting Complexity?"},"content":{"rendered":"

\"DoubleLabeling pathology<\/a> in another person is easy. One teacher of mine said it\u2019s like \u201cshooting fish in a barrel.\u201d Think of any person you know and, unless you\u2019ve totally idealized them, I bet you can find some psychological diagnostic label to pin on them. \u201cSo neurotic!\u201d \u201cSo hysterical!\u201d \u201cSo narcissistic!\u201d We all have the ability to spot apparent pathology. But we all, therapists included, sometimes have a much more difficult time recognizing health\u2014the 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 \u201chealth\u201d and \u201cpathology\u201d 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\u2014your car would not accelerate past 25 mph. Imagine the mechanic takes a thorough look at your car and says, \u201cWell, I can\u2019t see anything wrong. I think your car is fine.\u201d You might be more than a little concerned about your difference of opinion with the mechanic, and you\u2019d probably look for a second opinion.<\/p>\n

The same is true with therapists. Some emotional problems show up in big, visible ways\u2014a depression<\/a> that makes it hard to get out of bed, for example, or panic attacks<\/a>. However, some mental health conditions and\u2014more importantly\u2014the 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\u2019s issues, therapists are at risk of looking a suffering person in the eye and saying, \u201cYou seem fine to me.\u201d 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\u2019s issues, the therapeutic relationship<\/a> is deeply compromised when the person\u2019s issues are all <\/em>we can see.<\/p>\n

When All We See Is \u201cResistance\u201d<\/h2>\n

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

\u201cI didn\u2019t want to come today.\u201d<\/p>\n

\u201cI\u2019m only here because my partner said I need to be here.\u201d<\/p>\n

\u201cDoes therapy even work?\u201d<\/p>\n

It can be hard to imagine how progress can be made in the face of attitudes like these. It seems like \u201cpathologies\u201d like defiance, passive compliance and hopelessness<\/a> have totally taken over the people quoted above. It\u2019s hard to find any overtly \u201chealthy\u201d dimension of their comments.<\/p>\n

As a therapist, I encounter statements like these with great regularity, and I\u2019ve seen plenty of instances of \u201cresistance\u201d and \u201cpathology\u201d that are even more bold and provocative. It is incredibly easy to hear these comments and become hopeless\u2014if 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\u2019s 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\u2019s resistance and \u201cpathology,\u201d we forget that their sharing <\/em>of their resistance and sharing<\/em> of their \u201cpathology\u201d 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 \u201cresistance\u201d and \u201cpathology,\u201d 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 \u201cresistant\u201d person\u2019s 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 \u201cpigeonholing\u201d 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 \u201cbad\u201d and \u201cgood\u201d and \u201cmixed\u201d-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, \u201cCan I accept this part of me?\u201d<\/span><\/p>\n

When we as therapists relate only to the \u201cpathology\u201d and \u201cresistance\u201d 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 \u201cresistance,\u201d we relate only to their \u201cbadness,\u201d 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\u2019s error: \u201cIt\u2019s my fault the therapy didn\u2019t succeed. I\u2019m just too<\/em> resistant!\u201d<\/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\u2019s 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 \u201cturn against their defenses\u201d or helping them to \u201csee their resistance,\u201d 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\u2019s 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 \u201cbad.\u201d This can be a reenactment of problematic attachments from the person\u2019s past.<\/p>\n

The Therapist\u2019s \u201cPathology\u201d<\/h2>\n

Your therapist\u2019s 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 \u201cpathological\u201d 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 \u201cpathology\u201d?<\/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 \u201cresistance\u201d may actually be our most profound effort to reach out? Can we accept our \u201cresistance\u201d 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, \u201cCan I accept this part of me?\u201d 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\u2014therapists 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":{"_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"],"_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}]}}