@soonny002

3 weeks ago

Hey Mark, psychiatrist and therapist here; I'm sharing my views again while you're still on the topic of therapy. It's nothing critical; I'm only expanding on what you have covered. Here's a secret that most therapists won't tell you... and I'll probably be murdered for this. We therapists have known for a while that all therapeutic techniques are similarly effective. Thus, we have theorized that the patient-therapist relationship is doing the heavy lifting rather than the therapy itself. Unfortunately, therapists have allegiance to their style and professional body and can, therefore, become quite cultish about their practices. For example, the CBT purist will claim that CBT is best, while the Freudian/psychoanalytic therapist does the same. They will even go as far as bad-mouthing each other, and It becomes even messier when you layer the therapist's financial interests on top of it. It is less helpful to focus on individual parts of therapy, such as 'self-awareness,' because that, too, can become a source of neurosis. You are correct that too much or too little self-awareness can lead to problems, but so is worrying too much about having an exactly 'right' amount of it, which is also a form of neurosis. It is the classic trap of being anxious about our anxiety. And by the way, self-awareness is funny - you can help people get more of it, but the opposite is almost impossible. Once you know yourself, you can't unknow yourself. Rather than considering which therapy or therapists are better, consider a patient's developmental needs instead. Validation is such a powerful tool in therapy because most parents spend a lot of time invalidating their children to produce a kind of behaviour that is convenient for them. When a therapist validates a patient, they are effectively meeting a developmental need to facilitate or resume psychological growth that was otherwise stalled or arrested at a young age. This explains why every psychotherapeutic styles are equally as effective as long as the therapist is meeting the patient's developmental needs (i.e. it doesn't matter how you feed the baby as long as you feed them). However, validation alone is not sufficient for psychological growth. A good parent will encourage their child to play and explore their world while always remaining in the background as a secure base if the child grows weary and needs to return home. This helps foster curiosity, safety, and individuality - all essential components of a healthy and effective human mind. A patient will internalize their therapist as the 'ideal parent' to satisfy their developmental needs if their therapist is attuned to them. Unfortunately, the therapists themselves can sometimes (not always) have trouble encouraging their patient to separate. This can be due to the therapist's unmet needs, but it is most commonly due to financial reasons. Therefore, I always caution against longer-term indefinite therapy because that almost always creates a co-dependent relationship with your therapist where the patient relies on the therapist for soothing while the therapist relies on the patient for their livelihood. There isn't anything inherently wrong with this arrangement... but the patient has to be informed. Depending on the severity, duration, and age at which a trauma took place, some neuroses can be far more severe than others, which is akin to permanent brain damage. A very young brain (i.e. age 0 - 2) is very plastic and vulnerable to trauma. People who are traumatized repeatedly during that age will likely require much longer and more intense therapy. However, your average Joe is probably a lot more resilient than that. It goes without saying that your genetics also play a role here. Although I agree that the 'do-not-fix-what-is-not-broken' philosophy is generally pragmatic, a neurotic person cannot tell what is broken or what isn't. Therein lies the dilemma. That is why we still see patients who have a seemingly good life but continue to struggle with anxiety and depression, regardless of their levels of self-awareness. Here's a tip for you and your viewers: If you ever find yourself running out of things to say with your therapist, that is a sign that it is time to review your goals and ask if the therapist has anything else to contribute. You might be in it to avoid upsetting your therapist, and they might be in it because they need the money. Again, there isn't anything inherently wrong about this, but it has to be said out loud so it is on the table.

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