IS PSYCHOTHERAPY A LUXURY?
(into the dialog with “Mental Health Services” of Toronto)
The idea that psychotherapy is a luxury has been announced a hundred times. We have heard it from many representatives of different agencies, centers and more. Every time it has been mentioned in passing and sounds like a synonym for the sentence “we can’t afford it because it is expensive, and we don’t want to provide it because it is not essential”.
Let’s have a look at the “affordable” approaches now being practiced broadly. A good example is the solution-focused therapy. The therapist practicing this approach concentrates his attention on the concrete problem (how it exists for the client at the certain moment) and on the way of solving it which is possible for the client at a certain stage of his life. The result this therapy leads to is undoubtedly valuable: what the client currently can’t do, don’t understand, or is afraid of after the therapeutic cycle becomes performable, understandable and no longer scary. So when we look at the correlation of the problem scale, the “spent amount” and the received result, we can see that they match each other. And we don’t interpret it as a luxury.
What kind of correlation do we have being focused on the other therapeutic approaches, based on the developed therapeutic relationship and demanding prolonged time (Gestalt-therapy, Existential therapy, Psychoanalysis and so on)? Any kind of client’s requests are supposed to be considered in the context of his/her relationships, life connections, or even whole life. Very often the issues discussed at the session don’t sound like they are related to the problem the client initially proclaimed. There is only one criterion which makes sure “we are doing what is necessary”: the client’s feelings that what’s going on is really important for him/her. When the time to sum up comes the client discovers many more new and important changes: some of them are related to the initial problem, some of them belong to completely different realms of client’s life.
Examples are very expressive.
B. was an 11-year old boy suffering from asthma. The doctors in the sanatorium had the trouble with his behavior, and suggested his mother to add a psychotherapeutic treatment to their approach to treating his asthma. B. agreed to come to a psychotherapist because he wasn’t happy with his relationships with his classmates.
After 18 psychotherapeutic sessions the therapist had a meeting with B.’s mother. She described her son’s behavior as very changed: not only the sanatorium doctor stopped having problems with B.’s disobedience, but she herself noticed that all interactions with B. became easier, he stopped his constant resistance, and his attitude toward rules lost tension. Additionally – what made the mother particularly surprised and happy – “the picture” of his disease totally changed: fits of asthma disappeared.
In this case we can see that the results of the therapeutic cycle encompassed spheres of B.’s life which were not even brought up at the initial stage of the therapy.
Many other therapeutic cases illustrate the same phenomenon: the results of the therapy are bigger that the request.
A man complained about his over-anxiety related to his little daughter – after the therapy he found completely new aspects in his fatherhood and got a promotion at his job.
Another man felt “something like depression coming”. At the last therapeutic session he reported that the depression symptoms disappeared and his relationship with his wife lost the “shadow of conflict”.
A young woman suffered because her boyfriend broke her up. After the therapy she described her relationship with that guy as “a stage” in her life and totally reconsidered her relationships with her parents making he much more independent.
The line of examples is endless. They show that the “product” of therapy based on the developed relationship doesn’t correspond to the client’s request “one to one”; more accurately it is “one to many”. Recently I was very pleased to find a small article about psychodynamic therapy in “Psychology Today” (June, 2010). The author proclaims the fact that although many people view this method as ineffective or at least unsupported by clinical evidence the beneficial effects of the psychoanalyst’s work may be much more extensive. “Jonathan Shedler of the University of Colorado examined several meta-analytic studies… and found that not only did the psychoanalytic method often yield greater symptom reduction than cognitive-behavioral therapy or medication, but patients continued to improve long after they stopped attending sessions.” One of the reasons for such effectiveness is related to the specifics of psychodynamic therapy – it is focused on the whole person, not on the local problem or the certain symptom. ”It aims to accomplish much more because most of the time, emotional suffering is not an encapsulated “disorder” but is woven into the fabric of the person’s life”.
It is remarkable that the “meta-analytic” studies mentioned above and my review of my own professional experience (I am a Gestalt-therapist) could extract conclusions which are so similar. We can summarize: there are therapeutic approaches which are focused on the whole person, which consider emotional suffering as an aspect of the whole personal life (not as a symptom or a local problem), and which may yield results related to the whole person’s current and future life (not to a concrete life situation. Although we have to admit that sometimes a specific life situation may be fatal or decisive for the rest of person’s life). Certainly, these approaches are time-demanding. (Those rare cases when extremely efficient therapy lasts 2-3 sessions are worth analyzing in another article.)
The answer to the question “is psychotherapy a luxury?” now is closer than it was at the beginning: -psychotherapy is expensive (because it is time-demanding);
-outcomes of psychotherapy embrace many different sides of client’s life, harmonizing the whole life (which may remain luxury).
Now we have one more interim question: “Is this kind of outcome essential?” If “not very much” – psychotherapy is a luxury. But now we are crossing the border line between the areas of objective vision and subjective perception. The issues of “meaningfulness” and “significance” belong to the area of subjectivity. For the psychotherapeutic context it means that the decision about the necessity of the therapeutic cycle can be done only subjectively.
So we can return the initial question “Is psychotherapy a luxury? – For whom?
- For the mentally sick person – (in combination with psychiatric assistance) it is the chance to restore connections with society and themselves, and overcome the fear and horror of “madness”. People with these conditions are not good in making decisions and definitely need help from society. Mental illness causes severe suffering, and what ever can be done to relief it – it is just a necessity.
- For the neurotic person (even if this functional disorder is severe) prolonged and relationship-based psychotherapy is the opportunity to get rid of the chronic psychological tension which in its nature affects all sides of a person’s life and activities. No matter how the neurosis represents itself in each case – it has negative influences on health, on relationships with a family, with friends, with co-workers, on one’s self-attitude, etc. Thus psychotherapy for such a person is essential.
- For the person who has faced some predicaments or a new situation demanding a lot of energy, or which is controversial, or a crisis situation - the way of helping may be different. And honestly – only the person him/herself can know whether their actual capacity to manage is not perfect or the situation really is too new. Both ways are suitable: psychotherapy or counseling. The client decides.
…The circle has closed up. We have reviewed three aspects of psychotherapy: the scale of the submitted problem, the price for the service, the potential result. Only one person in the word can estimate the correlation between them: it is a client (except of those cases when the ability to make choices and decisions is broken).
Is psychotherapy a luxury from client’s point of view? – For some people – yes, it is (they don’t need it). For some people – it is an affordable necessity. For others – it is a non-affordable necessity, and for some of them – it is vital and non-affordable…
I like your way of thinking about the aims of psychotherapy.
And you are right: it is extremely hard for parents to handle the psychological problems of their children. More often the parents are - directly or indirectly - the part of the problem. Not each time though...
I like your way of thinking about the aims of psychotherapy.
And you are right: it is extremely hard for parents to handle the psychological problems of their children. More often the parents are - directly or indirectly - the part of the problem. Not each time though...