Your Therapist Might Secretly Be Wondering: Are You the Problem?

              After a smile and a handshake, my job as a therapist starts out by asking what the problem is. What are we working with here? Next comes the context. Would you be surprised to know that your therapist might be asking herself if you are part of the problem?

              Conceptualizing our patient’s concerns within the context of their life requires us to ask ourselves what caused/is causing the problem and what is perpetuating it. If it sounds derogatory to ask if you are the problem, it is not. You should hope you are the problem because then you also have the power to change your situation. Is what you are doing (or not doing) causing your stress? Is the lens through which you view the world distorted making everything seem worse than it is? Is the way in which you think and process information skewed to work against you?

              There are all sorts of ways in which humans impact their own circumstances, both good and bad. Therapists are searching for these culprits to problem-solve how to make improvement. If you are depressed, you shouldn’t be isolating yourself from loved ones and no longer exercising. If you are having panic attacks, reduce caffeine intake and start a mindful meditation routine. If you have low self-esteem, we must work on how you speak to yourself. You are in control of these behaviors and so these are the low hanging fruit when trying to guide patients toward healing.

              Your therapist is looking at the broader context that might be playing a role. Strong family histories of depression put you at a higher likelihood of developing depression yourself. Consider the degree to which being marginalized in your community or country due to a minority status affects your mental health. Working on self-esteem becomes near impossible when you don’t know where you are going to sleep tonight or if you unsure if you can feed your baby. Therapists work with clients within their context to make the best decisions they can going forward to cope with circumstances that are outside of their control that might be working against their mental health.

              Remember, your therapist can’t change much of your context. We can’t change your boss not liking you or you living in a homophobic society. We can’t bring your loved one back or change your brain chemistry so that you are more relaxed.

              Thus, it is not so terrible if you are the problem. That means you have the power to change your circumstances.

              I’d like to share a recent intervention I used with a longstanding client. I have seen him for over a decade and provided both medication management and psychotherapy through the years. He goes from not feeling great to feeling terrible. He never quite makes it to happy. I have been providing ERP (Exposure and Response Prevention Therapy) for his OCD and he has not gotten any better and at times, has gotten much worse. Our momentum started after I challenged him to consider what it would like for him to be happy. If there is some part of himself that is holding on to being mentally ill? My lovely patient broke down. He described his depression like an old friend and gave examples of connection with others through seeking support that would be missed if he was well. The problem wasn’t that ERP wasn’t working. He wasn’t letting himself feel better.

              A final note on therapists pointing out how you might contribute to your own downfall. Therapy isn’t nice. We need a relationship with our clients and a strong working alliance to create safety, but good therapy challenges you. Good therapy puts a mirror up to your face. Moving toward a better version of yourself is not comfortable nor does it feel good to acknowledge the parts of ourselves that are ugly. But we know making progress toward the person we want to be will provide healing. Know that if your therapist is challenging you or brings you to an uncomfortable conclusion, he is working for you and cares for you.

              So you better hope you are the problem! It makes fixing things a lot easier.

Feel better, y’all!