Psychotherapy & those who don’t fit

“They’re not a counselling crowd”

I was having some peer supervision last night and we were discussing those people who don’t seek counselling. In Australia at least this is probably quite a large group. Those people who are clearly suffering some kind of emotional distress and who never seek counselling. In particular we were discussing those people who suffered trauma as a child and have had psychological difficulties most of their lives but have never sought any significant type of psychotherapeutic assistance. They may have experienced long term  depression, anxiety, excessive alcohol use, poor work history, varying levels of illiteracy, at times some kind of imprisonment and so forth.

If asked why they don’t seek counselling they will say thing like – I just want to forget about it, it was long ago, I just want to move on and the like.

These people provide a dilemma for the counselling profession. We would say to them, “If you open up about it and talk about it then usually you will feel better in the longer term”. Most often this group have had someone, somewhere along the line (often multiple times) say precisely this to them. Whether that be a family member, spouse, friends or doctor.

Theory reality

But they never do. How do we deal with them or perhaps how do we view or understand them. Firstly they make us question our theories. Many (most) theories of personality have the assumption that people have some kind of drive towards health or some kind of positive emotional growth naturally within them. Freud’s theory of Eros (the life instinct) proposes precisely this, that we have a life force to grow and develop and create. Eric Berne certainly toke this on in this theorizing as well. Then we have Carl Rogers with his theory of unconditional positive regard that will naturally lead people to growth. Maslow and his hierarchy of needs says we all have a drive to self actualize. Petruska Clarkson talks about physis as a creative drive towards health.

All these theoreticians have probably used experience with their clients as a basis for their theoretical formulations. Nothing wrong with that, except one is left with a biased sample. What about all those who never come to counselling that these theoreticians never get to see. If we consider the crowd who never go to counselling and suffer, how does that change our formulations about human nature.

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Accepting the unbelievable

 

The theories of Eros, physis and self actualization one could argue are feel good theories. It feels nice to believe that humans have a basic drive towards health and growth. It is hopeful and optimistic to believe such theories. But that does not make them true or a correct representation of human psychology. But it does make us more likely to believe them because they feel good and are hopeful.

And speaking of hope. Maybe we need to reformulate our ideas about that as well. All psychotherapies say there is hope. All our theories say there is a solution to one’s emotional pain. We say a person chooses a life script as a child and we formulate the concept of life script such that there is always a solution. All people need to do is a redecision, or reparenting, or enter into relational contact and the problem can be solved. This is a positive optimistic view. But agin, because it is optimistic does not make it true. If we consider that sizable group who never want counselling even though they suffer, maybe they show us that sometimes there is no hope and things are not so positive.

Perhaps there is a life script where there is no solution. Maybe there is an injunction or a driver that is not treatable and that sizable group of people have it. To actually understand this takes some time and takes an expansion of how one thinks as all our theories are very structured so there is always a solution. Inherent in the very nature of our psychological theories this – there is always a solution – belief is woven into the very fabric of them since Freud began his formulations over 100 years ago. This is so central to how we think as psychotherapists we don’t even realize it at times.

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People are a diverse group. Maybe our psychological theories need to reflect that more so.

 

 

If we begin to accept the idea there at times is no solution then we can begin to understand that crowd who are just not into counselling and have little interest in seeking it out. That our theories don’t apply to all humans but only a subset of humans, the ones who seek counselling. If we begin to accept there is a, “There is no solution” injunction then we can understand. If we accept this then we do not have to seek an explanation to explain to ourselves how these people can exist. We don’t have to use our hope based theories to explain those situations where there is no hope of change. We accept that our hope based theories CANNOT explain them. This indeed is a liberating exercise in itself, to come to that kind of self acceptance. But it may also feel repugnant as the idea that there may be no hope for some is so quintessentially antithetical to what we have been trained to believe from day one and what we so strongly hope is not so.

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