by Gary Borjesson
I came to psychotherapy from philosophy, first starting therapy in my forties while on sabbatical from St. John’s College. I was struck by its transformative power—so struck that I ultimately resigned my tenure and returned to graduate school to train as a therapist. But I’ve hardly left philosophy behind. Freud reminds me of Nietzsche. Socrates’ fingerprints are all over the motives and methods of psychoanalysis. Donald Winnicott and Erik Erikson bring to mind Hegel, and the list goes on.
Philosophy and psychotherapy (and the humanist tradition in general) see our lives as developmental journeys. In the spirit of Socrates, they view self-exploration and self-awareness as essential to self-actualization. This may seem obvious, but it’s easy to lose sight of. Which makes it remarkable that many academics don’t believe being a “philosopher” need include examining themselves. Yet, how could it not? After all, philosophy means the love of wisdom, and who would say of a true philosopher what Regan said of her father, King Lear, that “he hath ever but slenderly known himself.”
It’s equally remarkable that the Socratic spirit is often absent in therapists, in their own lives and in their work with clients. A variety of forces (not least insurance companies) lead many therapists and clients to focus on techniques and tools for reducing symptoms; this draws attention away from the person as a whole. There is nothing wrong with focusing on symptom-relief, as the advertised “evidence-based” “solution-focused” therapies like CBT do. After all, people vary in what they want and need from therapy, so we should welcome experimentation and a variety of approaches.
That said, if therapy is to encourage deeper self-exploration, it needs to go beyond symptoms to the whole person suffering them. Thus “psychotherapy” as I mean it here is curious about the patient’s history, about who they are and want to be; about their gifts, passions, loves, hopes, fears, and aspirations. We typically call these depth therapies. The depth comes from deliberate attention to early childhood experience, unconscious processes, and larger questions of meaning and significance. Psychoanalysis and Jungian analytic psychology are prominent examples.
Depth therapies are often criticized for being inefficient and expensive, for lacking “evidence-based” methods and results, even for encouraging years of navel-gazing without tangible results. One might agree with some of these points and still conclude, as I and many others do, that they are the best approaches for those seeking to get to know themselves and to make lasting personal change. Depth therapy is vulnerable to such criticisms in part because self-exploration and characterological change are complex, gradual processes that can be effective, but are irreducible to simple methods. In contrast, it’s relatively easy to observe and measure progress when the goal is limited to evidence of symptom-relief. (It is not clear that these approaches bring lasting relief.)
Some years ago, a bright, sensitive 21-year-old started a session one day by saying, ‘I don’t think I’m going to deal with my addiction until I figure out what I want for my life….and to do that I’m realizing I first need to figure out what I think it means to be a good person.’
My eyes welled with tears, I was so heartened to hear this. For a year I’d been hearing how depressed and lonely he was, how painful (and sometimes fun) it was to get high all the time, how disagreeable his parents were being. But today he had turned toward a larger existential question. A question directed not to his symptoms, but to a search for meaning.
I thought of how Aristotle begins the Metaphysics: “Human beings naturally yearn to know.” My patient yearned to know, not from philosophical curiosity or academic interest, but because he was stuck. Having thoroughly surveyed his stuckness, he had a real question. It’s not that if he answered this question, then all his problems would be solved. But now, at last, he was asking his own question—an existential one that put his challenges in a larger, non-pathologizing perspective.
For example, as he started exploring what he might want, his view of his addiction shifted. Now instead of being a bad shameful part of himself, it appeared to him more as an obstacle to moving forward. He was heartened when I suggested that his substance use could be seen as a way he’d been trying to relieve his symptoms, but now he was finding it was more hindrance than help. Such re-frames made it easier to examine parts of himself he’d been avoiding, since now he began to feel and see how they were more misguided than bad.
I was also glad for him because it’s easier to face difficulties when you know where you want to go. Obvious, right? Yet, how many of us really know where we want to go? Even when we do know, it is easy to lose sight of the big picture and find ourselves preoccupied with our immediate situation and problems. Motivation comes more easily with a positive and informed vision of the good we want.
Over the years my students have pointed out, rightly, that many people sure don’t seem to desire to understand, and this makes Aristotle’s view seem naïve to them. But what this apparent contradiction actually reveals is just that learning and growth require favorable conditions. This is as true of acorns and amoebas as it is of people. Besides, as I often tell my patients (and the patient in me), even when conditions are favorable, there will be difficulties, pain, crises, traumas, loss, and grief. This is worth emphasizing; otherwise we risk pathologizing normal life experiences by taking ‘favorable conditions’ to mean ‘absence of resistance.’ This mistake fuels the harmful tendency of some parents to overprotect their children from difficulties and occasional failure, as if these were a hindrance, rather than a necessary condition, for growing up.
Philosophy and psychotherapy agree that meeting challenges is essential to growth—it’s part of the path. In his influential account of psychosocial development, psychoanalyst Erik Erikson observed that our lives are characterized by a series of crises. In the first 18 months of life, for example, the crisis concerns trust vs. mistrust. Good-enough parenting helps the child pass through this stage and internalize trust and hope.
Erikson reminds me of Hegel, who described the development of consciousness as a “highway of despair.” That’s not all it is, otherwise who would keep traveling down the road! For Hegel, the despair comes from questioning and sometimes from abandoning familiar beliefs and opinions and ways of being, for the sake of better knowing ourselves and the world. Similarly, psychotherapy includes feeling the anxiety, fear, and grief that comes while reckoning with our defenses—so that we can face parts of ourselves that, like my patient, we’d prefer to avoid, but which are getting in our way.
I started therapy because I felt stuck in a state of pervasive dissatisfaction. I knew the problem was personal, but it wasn’t until I was in therapy that I learned the extent to which the help I needed was interpersonal. Probably I should have known, it’s announced in the Greek root of psychotherapy, which means care of the psyche. Then again, one reason people seek therapy is because it’s hard to see our own blind spots. One of mine was thinking, in true Socratic fashion, that in therapy I’d find an ally who’d help me get to the root of my dissatisfaction. And I did find this.
But the transformative power came from an unexpected source. Not from insights and techniques, as valuable as these were. It came, rather, from the accumulated experience over months and years of my therapist’s steady, reliable, warmly intelligent caring attention. She didn’t offer much in the way of advice or tools; she knew (better than I did) that this wasn’t really the help I needed. Instead, she provided the thing that marks where psychotherapy takes its own path, becoming its own art: keen, artful attention to the therapeutic alliance, to provide the favorable conditions for self-exploration, especially of those pained, traumatized, ashamed parts of our selves that often stand in the way of healing and growth. I hadn’t expected that the warm alliance with my therapist would itself be key to the help I have received. Yet this is exactly what the research shows.
I could have told my patient what I thought he should do, and what tools would help. And sometimes, despite myself, I did. But this was the philosopher and teacher and anxious-to-help part of me getting in his way. From listening and getting to know him, I had learned something about the specific conditions favoring his growth. I knew, for instance, that he had high-powered overbearing parents who had been advising and cajoling and trying to rescue him for years. If what he had needed was information and advice, he’d have been thriving! What he needed, however, was what those who loved him found so hard to give: space, time and encouragement to ask his own questions, and learn what he thought and felt about his life—without having to defend against anxiety-driven parents pressing him to do what (they thought) was best.
I remember thinking that I wanted to do for him what my therapist had done for me: provide the favorable relational conditions that would allow him to give to those wounded, ashamed parts of himself the same warmly attentive regard that I was doing my best to give him.
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