WHEN YOU
DON'T KNOW
WHERE
TO TURN

A Self-Diagnosing Guide
to Counseling and Therapy

Steven J. Bartlett, Ph.D.

Contemporary
Books, Inc.
Chicago — New York

*****

ALSO BY STEVEN JAMES BARTLETT

Normality Does Not Equal Mental Health: The Need to Look Elsewhere for Standards of Good Psychological Health

The Pathology of Man: A Study of Human Evil

Reflexivity: A Source Book in Self-Reference

Self-Reference: Reflections on Reflexivity (co-edited with Peter Suber)

Conceptual Therapy: An Introduction to Framework-Relative Epistemology

Metalogic of Reference: A Study in the Foundations of Possibility

VALIDITY: A Learning Game Approach to Mathematical Logic

As editor of these books
by Paul Alexander Bartlett:

Voices from the Past — A Quintet of Novels:

Sappho's Journal

Christ's Journal

Leonardo da Vinci's Journal

Shakespeare's Journal

Lincoln's Journal

*****

Library of Congress Cataloging-in-Publication Data

Bartlett, Steven J.
When you don't know where to turn.

Bibliography: p.
1. Psychotherapy. 2. Counseling. 3. Consumer
education. I. Title.

RC460.B28 1987 616.89'14 87-20045
ISBN 0-8092-4829-8

Copyright © 1987 by Steven J. Bartlett, Ph.D.
All rights reserved
Published by Contemporary Books, Inc.
180 North Michigan Avenue, Chicago, Illinois 60601
Manufactured in the United States of America
Library of Congress Catalog Card Number: 87-20045
International Standard Book Number: 0-8092-4829-8

Published simultaneously in Canada by Beaverbooks, Ltd.
195 Allstate Parkway, Valleywood Business Park
Markham, Ontario L3R 4T8 Canada

*****

Project Gutenberg 2014 edition

Note that this is a copyrighted Project Gutenberg eBook; it is not in the public domain. Its license, see below, allows for free non-commercial distribution and prohibits its sale or use in derivative works by anyone without the copyright holder's written consent.

When You Don't Know Where to Turn was originally published in 1987 by Contemporary Books. All rights to the book have now reverted to the author, who has decided to make the book available as an open access publication, freely available to readers through Project Gutenberg under the terms of the Creative Commons *Attribution-NonCommercial-NoDerivs license*, which allows anyone to distribute this work without changes to its content, provided that both the author and the original URL from which this work was obtained are mentioned, that the contents of this work are not used for commercial purposes or profit, and that this work will not be used without the copyright holder's written permission in derivative works (i.e., you may not alter, transform, or build upon this work without such permission). The full legal statement of this license may be found at

http://creativecommons.org/licenses/by-nc-nd/3.0/legalcode

*****

This book is dedicated to Karen,
my love, wife, and friend.

Preface to the Project Gutenberg Edition

Nearly three decades have passed since When You Don't Know Where to Turn was first published. In that time, psychiatry, clinical psychology, and counseling have changed a good deal.

Psychiatry has continued on a now well-worn path leading to a more and more inflated universe of diagnostic labels, the majority of which have no known organic basis. Few readers who are not themselves mental health professionals realize that these diagnostic classifications are voted into existence by committees of psychiatrists whose pronouncements magically summon into being a lengthening list of so-called "mental disorders." These pronouncements are then applied to people in order to label their problems (as well as the people who have them), to match their problems with allegedly effective treatments, and in the process to give the impression that a respectable medical process of diagnosis and intervention has been undertaken.

And yet these so-called "mental disorders" do little more than equate designated patterns of behavior, emotion, or thought—called syndromes—with alleged psychological malfunctioning. Such syndromes are no more than sets of symptoms that can be collected together in a wide variety of different ways, but depending upon how they are grouped, distinguishable syndromes can be pointed to and named. This is a highly arbitrary process very much like fortune-telling using tea leaves, which depends on the pattern seen or imagined in the tea leaves at the bottom of a cup.

During the past three decades, clinical psychology and its less formal cousin, counseling, have also undergone noticeable change. They have been the traditional sources of a large number of diverse approaches to psychotherapy and counseling. But in the past thirty years, the large number of approaches to psychotherapy and counseling has, in practical reality, shrunk considerably. This has been due to the rapid dominance and virtual monopoly that has been gained by cognitive-behavioral therapy, also known as rational-emotive therapy. Insurance companies have been attracted like flies to the sweetness of the comparatively brief treatment period touted by cognitive-behavioral therapy, and practitioners have similarly been attracted by the ease of using its one-size-fits-all approach.

And so where the changes in psychiatry have been inflationary in its authorized catalogue of "mental disorders" known as the DSM (Diagnostic and Statistical Manual of Mental Disorders), clinical psychology and counseling have been on a deflationary course that has progressively narrowed the treatment options available to many people.

Despite the passage of time, When You Don't Know Where to Turn remains the only step-by-step self-diagnosing guide to counseling and therapy, a guide that seeks to direct individuals—by respecting and responding to the very great differences that exist among individuals—to approaches to counseling and therapy that may be most likely to benefit them—taking into account the nature of their own individual problems, their different degrees of willingness and abilities to learn and to change, and their differing individual situations in life, including their financial resources and the amount of time that they are willing to devote to therapy.

Such a customized, individually-centered perspective is not popular today. The human population continues inexorably to expand while our healthcare system insists on general applicability and streamlined efficiency. Individual problems in living are more easily and rapidly "processed" when they can be subsumed under specifiable diagnostic and treatment codes. In this increasingly mechanized process, the individual person and the individual problems of living he or she is attempting to cope with tend more and more to be ignored or neglected, and his or her diagnosable "disease entity" becomes the object of attention.

These comments are not a polemic against current trends and fashions; they are rather intended to place in perspective the changes that have occurred in the mental health field during the past three decades since the first edition of this book came off the press. What a reader might take away from these preliminary remarks are these suggestions:

* to recognize that, like so much that is a human production, today's classification system of mental disorders is unlikely to be the final word about the human condition, but that its proliferating list of mental disorders should be taken by the humble at least with a grain of salt, and rejected wholesale by those who are more critically inclined;

* to accept the fact that it is becoming harder with the passage of time to find one's way to a mental health clinician who is not recipe-oriented, due to the in-fashion monopoly that prescribes cognitive-behavioral therapy, and due to the pressures on the healthcare system to process people and their problems faster and at lower cost; and, finally,

* to realize that, when it comes to problems of living, those who are willing to accept a healthy measure of responsibility for their own choice of practitioner and treatment are most likely to find a practitioner and a treatment that meet their individual needs.

From this point of view, When You Don't Know Where to Turn continues to offer readers a heightened consciousness of alternatives to treatment that do still continue to available, though they can be somewhat harder to find in some areas of the country, and to give readers a sense of what those alternatives have to offer and for which kinds of problems and personalities they may best be suited.

Readers interested in learning more about the author, his research, and publications by him, many of which can now be downloaded at no cost, may like to visit the author's website:

http://www.willamette.edu/~sbartlet

Steven James Bartlett
Salem, Oregon
2014

*****

This book offers counseling observations based on the author's experience only and makes no specific recommendations for any individual or group.

It is intended and has been written to offer the author's understanding and opinions in regard to the subject matter. The author and publisher are not here engaged in providing personal psychological or psychiatric or other professional advice. For such advice, the reader should seek the services of a qualified professional.

The author and the publisher cannot be held responsible for any loss incurred as a result of the application of any of the information contained in this book.

*****

CONTENTS

Before We Begin ... [xi]
Acknowledgments [xv]
The Purpose of This Book [1]

PART I: GETTING STARTED [7]

1 Prisons We Make for Ourselves [9]
2 Paths to Help [17]
3 Bridges from Here to There [29]
4 The Therapeutic Jungle, Part I:
Social Workers, Psychologists, and Psychiatrists [39]
5 The Therapeutic Jungle, Part II:
Outside the Mainstream [48]
6 Where You Can Find Help [54]
7 Self-Diagnosis: Mapping Your Way to a Therapy [59]
8 Emotional Problems That May Have Physical Causes [99]

PART II: EXPERIENCING THERAPY [111]

9 Psychoanalysis [113]
10 Psychotherapy, Part I:
Client-Centered Therapy, Gestalt Therapy,
Transactional Analysis, Rational-Emotive Therapy, and
Existential-Humanistic Therapy [123]
11 Psychotherapy, Part II:
Logotherapy, Reality Therapy, Adlerian Therapy,
Emotional Flooding Therapies, Direct Decision Therapy [150]
12 Behavioral Psychotherapy [173]
13 Group Therapy [184]
14 Marriage and Family Therapy [194]
15 Channeling Awareness: Exercise, Biofeedback,
Relaxation Training, Hypnosis, and Meditation [204]
16 Drug and Nutrition Therapies [227]

PART III: IMPORTANT QUESTIONS [239]

17 Locating a Therapist [241]
18 Should You Be Hospitalized? [252]
19 Confidentiality: Your Privacy [257]
20 Does Therapy Work? [267]
21 Life After Therapy [282]

PART IV: APPENDIXES [287]

Appendix A: Agencies and Organizations That Can Help
(United States and Canada) [289]
Appendix B: Suggestions for Further Reading [298]
Index [307]

ABOUT THE AUTHOR [313]

BEFORE WE BEGIN ...

* A recent study by the National Institute of Mental Health shows that one American in five suffers from some type of psychiatric disorder: 50.5 million Americans have one or another of eight serious psychiatric disorders, ranging from anxiety disorders and phobias to depression and schizophrenia.

* Of these, only one person in five seeks professional help. More than 40,400,000 severely troubled people do not receive any treatment.

* An unknown number of healthy, emotionally untroubled Americans enter therapy for reasons of self-development.

* More than 130 distinguishable therapies now exist.

* These therapies are offered by a variety of health care professionals, including social work counselors, clinical and counseling psychologists, psychiatrists, biofeedback therapists, and others. Their backgrounds, training, fees, and durations of treatment vary considerably.

* These professionals practice in a number of different settings: in private practice, group sessions, public and private agencies, hospitals, newly established nonhospital inpatient facilities, and in the context of educational programs.

* Most people who enter therapy do not know what alternative approaches to therapy exist or how to choose among them. They usually locate a therapist in a more or less random way.

* Most people fear the idea of entering counseling or psychotherapy. They do not have a clear conception of what to expect: they do not know in advance what the experience of therapy is like.

* For a variety of reasons, many people who think of going to a therapist are concerned about whether their relationship with the therapist will really be confidential. If you are especially concerned about privacy, you should be aware of several ways that confidentiality may be broken, what the laws concerning confidentiality are, and, in particular (what few people realize), how insurance claims for psychological care can invade an individual's privacy.

* Counselors and therapists tend to specialize in one or a small number of alternative approaches to therapy. Some approaches to therapy are most appropriate for treating certain problems or responding to certain personal interests; others are better suited to providing help with other problems and concerns. Choosing a therapist with an orientation that is right for you can be extremely helpful and can help you save much time, money, and energy.

These facts highlight the situation in counseling and psychotherapy that anyone faces who enters therapy today.

From them, you can see that there is a bewildering array of counseling professions, of distinct approaches to therapy, and of settings in which help is offered. This guide's intention and hope is to help you understand the alternatives, and to help you form your own judgment how it may be best to proceed.

The book hopes to give you real assistance so you may make a good choice—thereby saving you emotional investment, time, money, and the potential discouragement of avoidable false starts with therapies that may not help because they are not relevant to your goals, values, and personality.

Be patient. Take the time to think about yourself, your life, and your hopes for a better life. This book was written for you, to help you to improve your life, your self-esteem, and your relationships with others. They are worthy goals.

Nothing in this world can mean as much.

May you have the energy, courage, and perseverance to achieve them!

ACKNOWLEDGMENTS

I would like to express my gratitude to Dr. William Altus, then Professor of Psychology at the University of California, Santa Barbara, who went out of his way to encourage my first interests in psychotherapy when I was a graduate student there twenty years ago. To Professor Paul Ricoeur, I would like to express my admiration for his original contributions to Freud scholarship and my enduring gratitude for his willingness to direct my doctoral research at the Université de Paris.

I am indebted to Dr. Raphael Becvar, Professor, Marriage and Family Therapy, Saint Louis University, both for making it possible for a faculty colleague to learn from him in several of his excellent seminars and for his later comradeship. To my good friend, Dr. Thomas Maloney, clinical psychologist in Clayton, Missouri, I want to extend my warmest appreciation for his personal guidance and voluntary supervision of my first efforts in counseling. If ever the qualities of compassion, depth of understanding, humor, and genuine care are to be found in one person, they are in him. I would also like to thank Professor Lillian Weger, George Warren Brown School of Social Work, Washington University, St. Louis, for generously welcoming me into her fine seminar in psychodynamic models.

I especially thank Dr. Renate Tesch and Professor Hallock Hoffman, of the Psychology Faculty of the Fielding Institute in Santa Barbara, for making possible a writer's retreat in the California desert: the loan of their home in Sky Valley made writing the last group of chapters a special and memorable pleasure. One is fortunate to have such friends.

If this book became more readable after its first draft, it was due in great part to the conscientious energy of my wife, Karen, in spotting the weeds of obfuscation that seem to grow effortlessly in an academic's garden. I want to thank her for her patience, with both me and the book.

I would also like to take this opportunity to thank Miss Libby McGreevy, Assistant Editor, Contemporary Books, Inc., for her helpful suggestions and for her regular doses of encouragement that made writing this book a happy experience.

When You
Don't Know
Where
To Turn

THE PURPOSE OF THIS BOOK

I would like to introduce this book by telling you what happened to a real and likable person who ran into some very difficult times and as a result entered therapy.

Frank is a large man, a former college football player, powerfully built. He has always prided himself on his strength and determination. He used to be friendly and outgoing. He had a pleasant smile, complemented by his clear blue eyes.

Frank had worked for eleven years for a manufacturer of tools. Not long ago, he was promoted to the position of managing the company's sales division in a large midwestern city. Soon after Frank and his wife moved, his wife became pregnant with their third child. Frank had a well-paying job, excellent benefits, a pleasant home they had just bought, and a contented relationship with his wife. But in spite of these things, he became severely depressed. And he began to feel terribly frightened: he had to leave his desk several times each morning and again in the afternoon. He would go to the men's room, lock the door, turn on the water faucets, and cry.

Frank lost fifteen pounds in three months. He had a poor appetite, slept badly, and was very anxious around his co-workers. He couldn't understand what had happened to him, and he was unwilling to let others know how unhappy he felt. He was ashamed of what he took to be a weakness in himself: like many men, he was raised to believe that men shouldn't cry, and his crying bouts shook his sense of identity and stability. His marriage began to suffer. Frank and his wife seldom made love. Frank was irritable and impatient with his wife and his children. Frank's wife knew he was very troubled, but he refused to talk to her about it.

For several months, Frank fought against his depression. (If only he had been aware of the strength that he mustered to do this!) Then he reached a crisis and could not force himself to go to work. He stayed home with a bad cold, slept as much as he could, and was very short-tempered. He was crying a good deal. Frank's wife persuaded him to see a doctor. The doctor referred him to a psychiatrist. The psychiatrist saw Frank twice a week for two-and-a-half months, but Frank was troubled by side effects from the antidepressant medication he took under the psychiatrist's supervision. He resisted the idea of "taking drugs," so he decided to see a psychotherapist who, in cooperation with the psychiatrist, monitored Frank's condition as he gradually went off the antidepressants.

However, after five months, Frank did not feel he was making any real progress. He changed to another therapist who, his wife had heard, specialized in the treatment of depression.

Together, Frank and his new therapist came, over a period of months, to recognize that Frank's depression had resulted from two conflicts: Frank had hated his job but had refused to admit this to himself, and now his wife was pregnant again, and because of this added financial responsibility he felt forced to stay with his present job, where he had seniority, good salary, and benefits.

Once the basis for his depression was made clear, it was possible to begin to treat Frank's problem. His wife was very willing to encourage him to plan for a change of jobs, even though this would mean a temporary reduction in his income. Frank saw a vocational therapist and received guidance that led him to take some evening classes and then to become a computer programmer for a rapidly growing local company. His depression faded away, and he now seems genuinely to be content.

WHAT YOU CAN EXPECT FROM THIS BOOK

I knew Frank personally, as his therapist in a group. (His name, like all others in this book, has been changed, along with certain details about his situation.) With professional help, Frank was able to improve his life—his sense of self-esteem, his marriage, and his family life. It was a long and painful process, as much self-change can be. But perhaps Frank's experience might have been less painful, perhaps Frank might have felt less devastating isolation, and perhaps his path to a resolution of his difficulties could have been shortened if a practical guide to counseling and therapy had been available to him when he first decided to find help.

MAKING INTELLIGENT CHOICES

This book is about how you can get the most appropriate kind of help for your problems, goals, and personality. Specifically, When You Don't Know Where to Turn sets out to help you become adequately informed about the range of therapists and therapies—as these relate to your own assessment of your goals and interests—so that you will be able to make intelligent decisions about these issues:

* the kind of professional to seek out

* the type of therapy most likely to help you with a certain complaint or set of interests and values

* how to locate the form of therapy that seems most promising to you at a price you can afford and with an expected duration you can live with

* what setting to look for in which the help you would like is offered

This book uses two approaches, both presented here for the first time and both based on common sense and intelligent advance planning.

First, you will be able, through a series of carefully organized questions and easily followed instructions in Part I, to pinpoint one or more approaches to therapy that may be most promising given your initial objectives, problems, or interests. For the first time, a self-diagnosing map to the major approaches to therapy is made available.

Second, you will have the opportunity to glimpse what typically happens during the sessions of counselors, psychologists, and psychiatrists as they treat clients or patients using the different main approaches to therapy. You will come to see what the experience of therapy is like in these different approaches.

In other words, the self-diagnosing map will point you in the direction of one, and sometimes more than one, approach to therapy that may be most promising for you to begin the process of self-change, and you will then be able to gain an insider's perspective on that approach so that you can judge how well suited to you the approach is and how it compares to the other main approaches to therapy.

If this guide helps you choose a path to the kind of therapy that will be appropriate and useful to you, it will have done something worthwhile. A guide to counseling and psychotherapy should, however, do more than this.

OVERCOMING ISOLATION AND GETTING STARTED

People who are troubled tend to try to hide it. They frequently isolate themselves when they are distressed, so overcoming the desire to withdraw is the first order of business if they are to improve their lives and feelings.

One of the things this book sets out to do is to help you see that very likely the problems you are facing are not one of a kind. You have a lot of company; the difficulties you are having are probably very familiar to counselors and therapists. Realize that there are ways of resolving most problems and that doing so often is easier with the sympathy, empathy, moral support, friendship, or direction of a counselor or therapist than by yourself.

CAN YOU HELP YOURSELF?

However, sometimes it is possible to help yourself a great deal through your own initiative. This book will describe ways that you can be your own source of help and will pay particular attention to when it may be appropriate and safe to rely upon inner resources.

CLEARING THE CONFUSING JUNGLE

Most people are not familiar with the differences among the main kinds of "psychosocial" helping professionals—the various types of counselors, clinical psychologists, psychiatrists, psychotherapists, psychoanalysts, social workers, etc. Another purpose of this book is to clarify these labels, to describe how the approaches used by their practitioners are distinct and how they are similar, and to give an idea of how their fees and durations of treatment vary.

Individual chapters in Part II are devoted to describing the main varieties of therapy available today: psychoanalysis; psychotherapies; behavior-changing therapies; marriage and family therapy; group therapies; exercise, biofeedback, relaxation, hypnosis, and meditation; and drug therapy. Each approach will be described in the context of experiencing professional help and in terms of how and when it may be possible to apply the approach on your own. These chapters will help you understand what in general to expect if you choose a particular kind of treatment, how the course of treatment may go, and what point of view is shared by professionals who use it.

FINDING SOMEONE TO HELP

Part III of this book will describe how you can go about locating good professional care, whether from a family therapist, an analyst, a social worker, a psychiatrist, a clinical psychologist, or another kind of therapist. You will learn how you can find a reputable professional with a particular specialization, and you will be encouraged to ask him or her some useful questions before beginning treatment.

As we will see in detail later on, there are numerous settings in which counselors and therapists work. Many are in private practice, but many also work for a variety of agencies, both public and private, for hospitals and newly established nonhospital residential facilities, and even for educational institutions. We will discuss each of these settings in Part III so that you will have a clear idea both of the alternatives that exist and of important factors to consider when deciding among them.

SHOULD YOU BE HOSPITALIZED?

"Should I consent to hospitalization?" "What will I encounter if I accept hospitalization?" "Is it necessary, is it desirable?" Another chapter in Part III is devoted to answering these and related questions.

IS YOUR PRIVACY PROTECTED?

In many ways it will be, and in other ways it may not be. Confidentiality as it relates to the treatment of emotional or psychological difficulties is a thorny issue, one that worries many people. In Part III, a chapter is devoted to a discussion of this potentially important area of personal concern.

DOES THERAPY WORK?

You may, of course, feel a certain amount of skepticism about the real utility and effectiveness of any one of the many therapies that now exist. This is, in my judgment, a healthy skepticism. A chapter in Part III will review what you may be able to expect, and perhaps should not expect, in the light of recent evaluations of the effectiveness of the main therapies. To complement these as yet incomplete scientific findings, I will emphasize a measure of ordinary common sense as we go along.

LIFE AFTER THERAPY

The last chapter in this book deals with what to expect after therapy. Recurrences, future crises—they often come with the package: life! Relapses—re-experiencing feelings of distress—have received too little attention. Often, old habits and feelings remain with us and reappear during times of stress. Too, we know that as life goes on, we need to be able to tackle new problems and new situations and sometimes must handle unexpected crises. Chapter 21 tells you how the experience of therapy will help you cope with possible setbacks and the uncertainties of the future.

PARTI
GETTING STARTED

1
PRISONS WE MAKE FOR OURSELVES

Which of us is not forever a stranger and alone?
Thomas Wolfe, Look Homeward, Angel

What other dungeon is so dark as one's own heart! What jailer so inexorable as one's self!
Nathaniel Hawthorne, The House of the Seven Gables

When you have shut your doors, and darkened your room, remember never to say you are alone, for you are not alone, but God is within, and your genius is within.
Epictetus, Discourses

When people are in pain and most need others, many wall themselves in. This very human tendency is illustrated by a famous story.

In 1934, Admiral Richard Byrd led an expedition to Antarctica, where he established a base on the edge of the Ross Ice Barrier, 700 miles north of the South Pole. Byrd then decided to set up a small weather observation post closer to the pole, which he chose to man alone. He would stay in a one-room cabin, a box that measured nine feet by thirteen feet, lowered into a rectangular hole cut into the ice to protect the cabin from gale-force winds during the coming winter months.

Byrd was committing himself to a degree of personal isolation few men have ever taken on. What happened to him in the months ahead reveals something important to psychologists that all of us should bear in mind.

Byrd's men left him in his tiny station and returned across the ice to the main base 123 miles to the north. Winter blizzard conditions soon surrounded Byrd. He knew he was in for a long period of solitary confinement, with no hope of returning to the base, even if a medical emergency demanded this. He could never make the return trip to the base on his own, and it would be too dangerous for a team of men to try to get to him in the winter darkness across the miles of ice.

After several months of isolation, Byrd became very ill. He was distressed and confused about his condition—nausea, vomiting, terrible headaches, blurred vision, great weakness. Days would go by, and he would cling to life by a thread, his mind wandering, drifting in and out of the dizzying incoherence of frequent comas. He would, by sheer force of will, gather his reserve of fading energy and stagger across the tiny room to light the stove and open a can of food, which he soon lost from his stomach. Gradually, he came to realize that the fumes from his kerosene stove and from the gasoline-powered generator for the telegraph were poisoning him. But if he turned off the stove, he would freeze to death, and the telegraph was his only contact with others.

He knew his life was in real danger, yet he refused to let his men know of his desperate situation. Nor could he admit to himself that he was in trouble.

Listen to his own words, written half a century ago, in his snow-buried room with the air heavy with fumes and the inside walls encrusted with glistening ice:

It is painful for me to dwell on the details of my collapse.... The subject is one that does not easily bear discussion, if only because a man's hurt, like his love, is most seemly when concealed. From my youth I have believed that sickness was somehow humiliating, something to be kept hidden....

To some men sickness brings a desire to be left alone; animal-like, their instinct is to crawl into a hole and lick the hurt.

There were aspects of this situation which I would rather not mention at all, since they involve that queer business called self-respect....

For a reason I can't wholly explain, except in terms of pride, I concealed from [my] men, as best I could, the true extent of my weakness. I never mentioned and, therefore, never acknowledged it.... I wanted no one to be able to look over the wall....[[1]]

[[1]] Richard E. Byrd, Alone (New York: G. P. Putnam's Sons, 1938), pp. 166, viii, 294-295.

In spite of his efforts to keep his condition to himself, Byrd's radio operator at the main base seems to have intuited that Byrd was in danger. A rescue party was sent as the winter weather became less harsh, and Byrd was brought back to the base, probably just in time, before the fumes killed or permanently injured him.

In many ways, Byrd's Antarctic experience parallels that of many of us who, because of our own pain and hardship, isolate ourselves from others. Our lives become cold, desolate, despairing. Our suffering is real, but for one reason or another we cannot or will not reach out to others.

WALLING YOURSELF OFF FROM OTHERS

Most of us are aware of a need for human company and companionship. But when we are in pain or are severely troubled, we often forget what has been recognized for a long time:

Frederick II, the thirteenth-century ruler of Sicily, believed that all children were born with a knowledge of an ancient language. When they were taught the language of their parents, however, he theorized, their knowledge of the older language was overridden and blotted out. King Frederick hypothesized that if children were raised without being taught a language, they would, in time, spontaneously begin to speak in some ancient tongue.

He therefore appointed a group of foster mothers, had new-born infants taken from their natural mothers, and ordered the foster mothers to raise the children in silence.

The upshot of this early experiment—as the legend goes—was that Frederick never found out whether his theory was true. All of the babies died. They could not live without affection, touching, and loving words. Apparently, the foster mothers withdrew all human warmth when they sought to obey the king's order.

Today, we are aware of a baby's vital need for affection, for human contact—and even so, in our adult lives, when human contact is equally essential, we sometimes cut ourselves off from others.

THE MYTH OF SELF-SUFFICIENCY

As adults, we tend to emphasize self-control. We think of ourselves as responsible—to ourselves, our parents, our employers, our children. All this responsibility can sometimes be a heavy load! During periods of illness or emotional crisis, the emphasis on control can be excessive. It can create the bars of a prison, a grillwork of defenses that stands between us and others who are able to offer encouragement, warmth, understanding, and direction.

There is no lonelier person than someone who has decided to take his or her own life. The decision is the ultimate form of self-isolation. It is the ultimate admission that one's imprisonment is final and that there is no escape.

Fortunately, the decision to take one's life is reversible, if the person is helped in time. The help may come from within or from without, but it always involves the recognition of hope that the self-imprisonment may not be final, that there are others who would help, that, even for someone who is terminally ill, there may be periods of satisfaction and joy that make living worthwhile.

Western European, American, and Japanese societies are very control-oriented. There is much evidence that when members of these societies are emotionally troubled they often perceive a fault within themselves. They see their troubles as springing from a loss of self-control: "Just pull yourself together!" "It's just a matter of self-discipline, of will!"

The greater our sense of responsibility—the more we emphasize personal control over our inner and outer affairs, the more we see ourselves as individualists whose individualism is based on strength of will, discipline, guts—the more we are trapped by the myth of self-sufficiency.

People who as children were forced to become independent too early, who lacked a long enough period of closeness to their mothers, whose parents were immature and self-absorbed frequently develop what is called pseudo-self-sufficiency or premature ego development. Such a person is the neurotically extreme form of the "do-it-yourselfer." He or she refuses to relinquish control, whether to the car mechanic, the sewer cleaner, or a lover. There is an urgent and obsessive need to maintain control, never to be "out of control."

For such people, anxiety, depression, and loneliness can be especially devastating because they have walled themselves in to such an extent that emotional growth and change are blocked.

Yet most of us share, to some extent, this belief in self-sufficiency. It is one of the most tenacious forms of self-imprisonment that we have available to us, literally at our own disposal. It is a prison we often take great pride in. Pride, control, and self-sufficiency are usually close friends. They keep us from having real friends and stand in the way of our being good friends to ourselves.

THE FEAR OF BEING LABELED EMOTIONALLY DISTURBED

It is woven into the fabric of our society that we should conform. A young teenager from Australia now in a California high school tries as quickly as possible to lose the accent that differentiates her, that makes her the object of laughter. The same pressures motivate the stutterer to keep quiet, speaking only when absolutely necessary. The National Merit Scholar says "ain't" among his school friends to be one of them.

Children are especially sensitive to covert expectations, the implicit shoulds that are handed down from the adult world and are frequently refashioned to fit the stages children move through.

At each stage, the implicit maxims are dress alike, talk alike, think alike. Be "in." Especially, have the same feelings, values, and hopes. Most of us are raised to fear being different because we might come to be a lonely minority of one.

But when we become ill, especially if we are emotionally troubled, the rules change radically. Animals, from the aquarium angelfish to the household dog or cat, seem to have an instinct to seek isolation when ill. This tendency probably has evolved because it contributes to survival: the sick animal can more easily rally its energy for self-healing in quiet, undisturbed by others of its kind. And going off to be alone reduces the chance that the animal will spread any disease it has.

Added to an animal's self-isolating tendency is the tendency to hide the very signs of illness or injury. An animal that shows signs of injury or illness is immediately a target for predators who look for the weaker members of the species.

We human beings also tend to choose solitude and to hide the revealing symptoms of sickness or injury. Admiral Byrd admitted to these defenses only in his loneliness. But it is important to realize that hiding our feelings and isolating ourselves frequently are not in our best interests.

Animals do not practice medicine, though many species are capable of offering moral support and even a certain amount of physical assistance, as in the case of a sick whale who may be supported by its fellows in the water in order to breathe. But only we have developed medicine, and we have more recently begun to develop ways to treat problems that affect our emotions, attitudes, and behavior. When individuals, perhaps instinctively, distance themselves from others and bottle up their malaise, they turn their backs on the educated assistance and goodwill that are available.

Sometimes we do so out of fear of treatment coupled with fear of admitting that we are not as self-sufficient as we want to believe. But more often in the case of problems that directly affect our moods—i.e., "psychological problems"—we feel ashamed and afraid of the stigma, the disgrace, that our society attaches to those who admit they have unhappy or confused feelings.

There can be little doubt that society is unbalanced in legitimating physical sickness while reacting with alarm and repugnance to problems of a psychological nature. Think of the discrimination against psychological disorders, in favor of physical complaints, practiced openly by nearly all health insurance companies, offering reduced benefits for mental health. Psychological pain does not hurt any less because it is emotionally based. Even so, emotional distress is held suspect, and insurance coverage for it, if not ruled out completely, is frequently only partial. It was, after all, not more than a century ago that our mental hospitals were run with an inhumanity that still can send shivers down one's spine. Unhappily, it is clear that we have not entirely left this phase of our development: the film One Flew over the Cuckoo's Nest, for example, points to continuing inhumanity in some psychiatric hospitals. And there is the alleged case of a Ukrainian woman who was involuntarily committed and held for some thirty years in a mental hospital. She was thought to be insane because, unfortunately, no one involved in her case recognized her "gibberish" as Ukrainian!

Emotional and mental problems are still not accepted by many. There is a fear of the unknown and a skepticism that psychological problems are nothing more than signs that a person is malingering, simply does not want to try to get better. And there is a gut-level anxiety when confronted by someone who, we worry, "may be close to going over the edge."

TEARING DOWN PRISON WALLS

What undue hardship this causes! As wonderful as the body is, we accept its imperfections, its susceptibility to disease and injury. But our brains, our minds, our spiritual dimension—how less well we understand these in their greater complexity! Is it so strange and unacceptable that they should be prone to their own problems, that they, too, may bring suffering?

Because society does not legitimate emotional pain, many people are not able to see their own pain as legitimate. So they deny it, to themselves and to others. But pain is usually a healthy signal; it tells you that something is wrong: Withdraw your hand from the fire! Move your cramping legs! Do something about your abusive, alcoholic husband! Get help for your depression!

Every one of these pains is a warning. To ignore all except those that are physical would be like saying that we are only bodies, without feelings, without humanity.

When you are in pain, whatever its source and kind, pay attention to it! Pain is often what points to a better life.

It is surely better to cope with a label applied in ignorance by some members of society, if this must be, than to live an unsatisfying and painful life. You must not manage your life just to avoid the potentially critical judgment of people who are ignorant of, or who refuse to acknowledge, the realities of human psychology. You can feel sure that among well-informed people, if you have had to deal with alcoholism, drug abuse, a difficult marriage, job depression, or any other "psychological" problem, you will be thought to be just as "respectable" as if you had coped with major surgery after an automobile accident. In fact, since overcoming a psychological difficulty demands a great deal more of your own voluntary effort, coming up a winner will increase your own self-respect and the respect, and even admiration, of those whose judgment is meaningful.

The first step to freedom from pain is to become aware of the walls of the prison that shut you in. Only then can you begin to

2
PATHS TO HELP

To wrench anything out of its accustomed course takes energy, effort and pain. It does great violence to the existing pattern. Many people want change, both in the external world and in their own internal world, but they are unwilling to undergo the severe pain that must precede it.

Rivers in extremely cold climates freeze over in winter. In the spring, when they thaw, the sound of ice cracking is an incredibly violent sound. The more extensive and severe the freeze, the more thunderous the thaw. Yet, at the end of the cracking, breaking, violent period, the river is open, life-giving, life-carrying. No one says, "Let's not suffer the thaw; let's keep the freeze; everything is quiet now."
Mary E. Mebane, Mary, Wayfarer

If you decide to enter therapy, your therapist will probably ask you to think about two interrelated questions (they may be expressed in a variety of ways): "Where are you now?" and "Where do you want to go?" Your therapist or counselor will, as he comes to know you, often be able to help you to answer these by sharing his perceptions of you. One of the main tasks of the counseling process is to help a person gain improved self-understanding that embraces both present problems and future goals.

Yet if you can gain a certain measure of self-understanding and self-direction before entering counseling or therapy, it will be easier for you to choose an approach to counseling or therapy that more closely fits your problems, values, objectives, available time, and even your financial needs. You should find in this book a basis for preliminary self-counseling that will give you a sense of how and where best to begin therapy.

It is important to recognize that none of us ever reaches a final state of self-knowledge: as long as we live, our self-understanding is capable of growing. What we really understand about ourselves and what we believe ourselves to need and want are never more than provisional, tentative. Additional experience, just the fact of living longer, very likely will lead you to perceive yourself differently and motivate you to modify your priorities and change your goals.

WHERE ARE YOU NOW?

Late in 1984, the National Institute of Mental Health released the first published results of the largest mental health survey ever conducted. The results are startling and are an unhappy commentary on our society and world.

The report shows that 20 percent of Americans suffer from psychiatric disorders. Yet only one in five of these seeks help. The others live with their suffering.

The most common problems are these:

Millions of Americans Psychiatric Name of Condition with This Disorder
Anxiety disorders 13.1
Phobias 11.1
Substance abuse (alcohol, drugs, etc.) 10.0
Affective disorders (including
depression and manic depression) 9.4
Obsessive-compulsive disorders 2.4
Cognitive impairment 1.6
Schizophrenia 1.5
Antisocial personality 1.4

The NIMH study also shows that women are twice as likely to seek help as men. Two interrelated inferences are commonly made from this previously known fact: women are often more accepting of their emotional state (men in our society are taught to disregard their feelings, part of machismo), and women are less willing to allow pride to stand in their way of getting help (women are less affected by the myth of self-sufficiency).

The NIMH report indicates, too, that the incidence of psychological problems drops by approximately half after the age of forty-five. The below-forty-five years are usually those of highest stress. Above forty-five, individuals tend to become psychologically better integrated. This probably reflects increased maturity and a more accepting, calmer attitude toward life. The lowest rate of emotional disturbance appears to be in people over sixty-five. Yet there are many thousands of individuals over forty-five, and indeed over sixty-five, for whom life remains a difficult inner struggle.

The statistics from the NIMH study reveal how very wide-spread personal psychological difficulties are. Given the degree of complexity of our mental, emotional, and spiritual makeup, this should be understandable, especially when we take into account twentieth-century stresses that wear us down. Caught up as most of us are in our jobs, families, and daily worries, we are unaware that, in a very real sense, mental and emotional health problems have assumed epidemic proportions. If you bear in mind how fearful our society encourages us to be of admitting such difficulties, you can perhaps imagine how substantial the "iceberg" of psychological suffering is: most of it lies below the waterline of public consciousness.

The NIMH study results should encourage you, if you suffer from personal emotional difficulties, to realize that you are not alone in the problems you face. Knowing that there are many good and fine individuals with very likely similar problems may urge you to take an honest look at where you are now and then to try to decide what changes may be helpful to you: where you want to go from here.

If you are fortunate, you may already be aware of the main things in you and in your life that bring you distress. If so, you are one step closer to being able to do something about them. Many of us, however, have become so clever and effective in denying what we really feel that we have lost touch with our true selves. Desires to repair an unhappy marriage are shelved while the children are growing up; the unrewarding nature of a job is ignored because priority is given to financial security; you may be unable or unwilling to face the pain you bring to yourself and others as a result of a drug- or alcohol-abuse habit.

In most cases, it is not possible to gain the motivation and means to solve a problem until you are willing to accept that there is a problem that needs to be solved.

Because of the blinding nature of the habits you may have established, and because of your defensive desires to disregard what disturbs the equilibrium of habit, it may be hard to acquire a clear picture of where you stand right now. Sometimes it can be useful to check with others: how do they see you?

A close friend of mine, after years in her profession, began rather suddenly to feel how unrewarding her job was, and she began to suspect that she may have hidden these feelings for a long time. She had maintained a regular, almost once-a-week exchange of letters with her mother for twelve years. She knew that her mother kept her letters, so she went to visit her and asked if she might skim through them, paying attention to comments she had made over the years about her work. It quickly became clear to her that, consistently, she had had only very negative things to say about her job. After skimming through dozens of letters written over a period of years, she became convinced of her real and enduring feelings and changed her line of work.

Such self-knowledge does not usually come this easily. We may pride ourselves on honesty, but there are few of us who permit ourselves self-honesty to any real degree. Existential-humanistic psychologists have paid much attention to these ways that we live "in bad faith"—each of us trying to be a person he or she really is not and denying the person he or she really is.

We live in a society that emphasizes conformity, "being somebody," gaining status and wealth and a good position—yet these values may not coincide with being true to ourselves. Parental influences can be strong, as can expectations from our spouses. We internalize many of these values so that it becomes difficult to see who we really are and what we really want from life and from our efforts.

There are no easy routes to self-realization. We must all do a certain amount of hunting in the dark—or, as a colleague of mine likes to say, "scrabbling about"—for a sense of real identity.

Recognizing that your self-understanding is probably always imperfect does not mean that it is of little value. It is, in the end, all any of us has to go on.

It may be useful to ask people close to you what they perceive about you. Reading through a group of old letters, keeping a journal, or simply setting aside a few minutes for self-appraisal at the end of each day or week may also be enlightening. If you do this self-examination, gradually where you are and what you feel will become clearer, and then it will be natural and appropriate to ask what the next step is.

WHERE DO YOU WANT TO GO? WHAT KIND OF
PERSON DO YOU WANT TO BECOME?

Influences from society, your parents, your spouse, or your close friends make it difficult for you to know yourself. Defensive habits and fear of change also stand in the way. These are significant blocks to self-understanding.

When you turn your attention to the future, to what kind of person you want to become, you will encounter more blocks to overcome. Life is like that! It seems that few things come without effort and perseverance.

There are two major obstacles to designing the model of the person you would like to become. Because they can be so important, I want to introduce them early in this book. They are blame and guilt, and they are like the two ends of a seesaw.

When we appraise what we have done in our lives, we usually find reasons to blame others, or perhaps to blame limited educational opportunities, or social pressures, or discrimination—in short, our past environment: all the factors that limited our lives, interfered with the attainment of our hopes, and were not under our control.

On the other end of the seesaw sits guilt. And guilt is really blame turned inward.

If we try to pinpoint the factors that have been responsible for our lives not having turned out better, we tend to blame environmental limitations, or else we feel guilt for what we see as our own failings. Usually, we locate responsibility in both areas.

Most of us, however, have unbalanced seesaws. We usually blame things outside ourselves for our disappointments. Doing so is a habit that allows us to avoid responsibility for ourselves and, in turn, limits our future development.

On the other hand, some of us blame ourselves much too readily: we carry an exaggerated burden of responsibility, which weighs us down and also limits our growth as individuals.

Ideally, psychotherapy would like us to let go of so-called "past negative conditioning"—blame as well as guilt—so that we are free to choose who we are and will become. Even though this is certainly a desirable attitude, most of us cannot really forget and let go. We are all inheritors of a tenacious past: the influences of past events have a certain power over us, and we must either resign ourselves to being controlled by the past or fight its influence. The attitude we take toward the past will usually affect how we meet the future, often diminishing our freedom to change old habits and undermining our hope and faith in ourselves.

For example, if Jeff blames his limitations today on his parents, on the ways they influenced him, he may set goals for himself that are far from being freely chosen. Jeff may choose them in reaction to domination by his parents years ago. His parents may have tried to influence him to be a gentle, courteous person with artistic interests. But as a result of other past influences—for example, because of frequent moves of the family and repeatedly being bullied as the "new kid" at different schools—Jeff may feel hostile toward others, so (in reaction to his parents' influence and because of pent-up hostility) he decides to go into science (rather than art, for which he perhaps has a talent) and rejects gentle, courteous qualities in himself.

It is difficult to choose freely. Some psychologists do not believe it actually is possible. And yet, whether we are ever truly free or not, we still try to plan our lives, and we believe our plans (and frequently the lack of them) have something to do with what we make of living.

Most people who enter counseling or psychotherapy want to improve some aspect of their living. Individuals whose seesaw is weighted on the side of blaming outside influences too often come to feel it is too much work and quit therapy because they cannot accept the need to make choices and decisions in spite of past influences. On the other hand, people who blame themselves may be so guilt-ridden that they are impaired in their openness to the future and feel unable to initiate fundamental changes in their lives.

When you ask yourself, "What kind of person do I want to become?," try to be aware of the extent that your answer may be weighed down by feelings of blame and guilt. All too often we continue to perpetuate, unknowingly, the same old unsatisfying patterns because we are trapped by our habits of blaming others or ourselves.

If you feel bogged down by feelings of guilt or burdened by the limitations of an unfair past, it may be difficult for you to develop a freely chosen sense of direction. But perhaps you will be able to acknowledge that the guilt or blame you feel is an obstacle to be overcome. If so, you have defined an objective that you may use to decide what type of counseling or therapy may be a most promising first step.

What I am suggesting is that an obstacle that makes it hard for you to gain a sense of direction can itself point you in a direction. If there are blocks, it can be helpful to meet them head-on. In therapy, the phrase working through a problem often means exactly this.

Choosing what kind of person you wish to be is a process, not an event. It is not something that happens and then is over. Choice is something implicit in each day of your life; sometimes it is quite conscious, but it is often dulled by the unconsciousness of habit. Your personal goals may undergo gradual or abrupt change. Psychological growth is your response to these changes in outlook.

WHAT DOES THERAPY TRY TO DO?

Individual therapy or counseling (therapy for groups and families will be discussed in detail later) is really an attempt to build a bridge between answers to these two now familiar questions: "Where are you now, or what kind of person are you now?" and "Where do you want to go, or what kind of person do you want to become?" Think of therapy as an attempt to build a bridge so that you can pass from a present situation to a desired way of being.

Carl Rogers defines therapy as "a relationship in which at least one of the parties has the intent of promoting the growth, development, maturity, improved functioning, improved coping with life of the other."[[1]]

[[1]] Carl Rogers, On Becoming a Person: A Therapist's View of Psychotherapy (New York: Houghton Mifflin, 1961), pp. 39-40.

Psychiatrist Allen Wheelis takes this definition further:

Therapy may offer insights into bewildering experience, help with the making of connections, give comfort and encouragement, assist in the always slippery decision of whether to hang on and try harder or to look for a different way to try....

The place of insight is to illumine: to ascertain where one is, how one got there, how now to proceed, and to what end. It is a blueprint, as in building a house, and may be essential, but no one achieves a house by blueprints alone, no matter how accurate or detailed. A time comes when one must take up hammer and nails....[[2]]

[[2]] Allen Wheelis, How People Change (New York: Harper and Row, 1973), pp. 101, 107.

Therapy involves a three-fold relationship among a helping professional, the approach to therapy used by him or her, and, what is most important, the outlook of the individual client. In this book we will examine each of these three dimensions of therapy in some detail, but here we will concentrate on the one therapists generally agree is the most important: you—the kind of person you are, what your attitudes and outlook are, and, of course, how much you really want to develop or change. Your attitudes will determine, probably more than anything else, what variety of therapy you will most benefit from.

Therapists, like teachers (which they really are), find that their clients or patients can be divided into two groups: active and passive learners. When you go to a doctor with a broken arm, your relationship to your doctor is a passive one: you need only to cooperate as he examines your arm, perhaps administers an anesthetic, and sets the break. You may take medication for pain, and then you simply wait until, thanks to the body's automatic healing processes, the break is fused. The public's conception of medicine is predominately a passive one. To be a "patient" is for the most part to be a passive bystander: the physician is the active agent who brings about healing. There are occasional exceptions—for example, physical therapy and rehabilitation therapy after a serious injury or illness, when the patient must become more active and accept more responsibility.

As we will see, a few approaches to counseling and psychotherapy preserve, to some extent, the traditionally passive role of the patient. Most of them, however, require a good deal of initiative and just plain hard work on the part of the patient or client.

In building the house of one's life or in its remodeling, one may delegate nothing; for the task can be done, if at all, only in the workshop of one's own mind and heart, in the most intimate rooms of thinking and feeling where none but one's self has freedom of movement or competence or authority. The responsibility lies with him who suffers, originates with him, remains with him to the end. It will be no less his if he enlists the aid of a therapist; we are no more the product of our therapist than of our genes; we create ourselves. The sequence is suffering, insight, will, action, change. The one who suffers, who wants to change, must bear responsibility all the way. "Must" because so soon as responsibility is ascribed [outside oneself] the forces resisting change occupy the whole of one's being, and the process of change comes to a halt. A psychiatrist may help, perhaps crucially, but his best help will be of no avail if he is required to provide a degree of insight which will of itself achieve change.[[3]]

[[3]] Wheelis, How People Change, pp. 101-102.

WHY IS IT SO COMPLICATED?

For better or for worse, human nature is a many-splendored thing. It doesn't take an advanced degree in psychotherapy to know that people can have many different kinds of personal problems. This fact, if we appreciate it fully, makes more understandable why there are so many alternative approaches to helping people with their difficulties.

In the world of theory, a model is a simplified representation of reality. Your checking account record is a model, in just this sense, of how many real dollars and cents you have in the bank.

Here is a much simplified model that represents five main psychological, emotion-laden dimensions of a person:

Five main psychological dimensions of a person: feelings,
hopes, abilities, relationships with others, and behavior

We see right away that, for the same reasons that there are specialties in medicine—e.g., orthopedy for bones, neurology for nerves, dentistry for teeth—there should be special approaches that focus on different psychological dimensions of the person.

Something else you may see is that the five dimensions in the model are not isolated from one another. They interrelate and overlap a good deal. Just as a dentist must know about the orthopedy of the jaw and skull and the neurology of the teeth a neurologist and an orthopedist are expected to know something, though not in great detail, about dentition. Each of us is a unity of what all the medical and psychological specialties study in different ways, plus a good deal more, as artists, writers, theologians, and musicians make evident.

That more than 130 distinguishable therapies have now been developed may perhaps strike us, even so, as excessive. But efforts are being made to unify many of these approaches, and this book is one of them. Rather than talking about 130 different approaches, we will center our attention on the main categories into which the many approaches can be sorted.

One of the interesting and hopeful things that can be said about the multiplicity of approaches to therapy and counseling is that treatment by any one of them can often be of some help. For example, Helen may wish to stop drinking (a habit in the behavior category), and she may be helped by means of behavior modification. She may then find that, as a direct result, her self-concept (feeling category) has grown stronger, while her marriage (relationship category) has also improved. Or, Ralph may go to a vocational counselor who helps him define a direction (hope category) in keeping with his interests and aptitudes. Ralph goes back to school and develops a background (abilities category) that reflects these aptitudes and interests. The sense of direction he has gained helps Ralph stop using drugs (behavior), reduces his hostility and anxiety (feelings), and improves his relationships with others. In other words, a helpful change in one direction can often lead to noticeable changes in others.

However, there also are risks that we should not ignore: Sue goes to an analyst and learns over a period of months that her marriage to Fred was based on a sense of inadequacy Sue learned during her childhood. Her father was so highly controlling and critical of her that she was never able to develop a sense of her own value. Her husband, Fred, is also domineering and authoritarian, and he abuses Sue frequently, usually mistreating her through criticism, but he has sometimes also beaten her physically. Sue has accepted this without question for a long time, but due to the emotional support received from her analyst, she is beginning to develop a sense of self-esteem. As her self-esteem grows, she comes to realize that her marriage is a self-destructive relationship and decides to divorce Fred. Her therapy has been helpful to Sue, but it has, indirectly, resulted in a breakdown of her admittedly unhappy marriage. A change in one dimension can sometimes lead to an initially unintended change in another area.

IF IT HURTS, DON'T PROCRASTINATE!

One of the marvelous things about human nature is the ability to feel pain. This may seem like an odd thing to say, but reflect for a moment. Pain is frequently what spurs us on from an unsatisfying and even destructive situation to a better future. Pain tells you to jerk your hand away from a hot stove. A different kind of pain tells you it is time to get on with living, time to initiate some positive changes. Anxiety, sleeplessness, irritability, resentment, depression—they all can be painful inner feelings that tell us that all is not well in our inner selves.

It is well-known to counselors and therapists that, in general, the longer these signs of need are ignored, the longer it may take to help a person resolve the difficulties that have been pressing for attention. Distress is not easily buried. When suppressed, it tends to pop up again later, sometimes with increased severity.

We can, ironically, choose to be "strong" and ignore these messages from within, or we can listen to our feelings, pay attention to our hopes, develop needed abilities, seek to improve our relationships with others, and work to change some ways we behave that block our happiness.

Problems that concern your inner well-being and the health of your relationships with others who are important to you are better resolved than buried, and the earlier they are given the attention they deserve, the easier your path through change to a better life will be.

3
BRIDGES FROM HERE TO THERE

AN OVERVIEW OF THE FIELD OF THERAPY

THE HELPING PROFESSIONAL

Professionals in the fields of counseling and psychotherapy have a wide range of different backgrounds and perspectives. They can be broken down into these categories:

Social work counselors: counselors for individuals; marriage and family counselors; group counselors; and vocational guidance counselors

Psychologists: clinical psychologists; counseling psychologists; and psychometrists

Psychiatrists

Other therapists: religious counselors; biofeedback therapists; hypnotherapists; relaxation and meditation instructors; holistic therapists such as bioenergetics therapists, yoga instructors, and exercise therapists; etc.

The education, supervised training, and outlooks of these professionals vary greatly, as do their fees and the average length of time therapy can be expected to last. We will look more closely at these differences later on.

THE RANGE OF APPROACHES TO THERAPY

Because of their differences in training and personal or theoretical preferences, the distinct classes of therapists represent a diversity of approaches to therapy. There are numerous schools of psychoanalysis, psychotherapy, behavioral therapy, group therapy, and marriage and family therapy, and a range of approaches to personal adjustment, including exercise therapies, relaxation techniques, forms of meditation, and drug and nutrition therapies.

From any one of these, a multitude of schools of thought branches out. For example, psychoanalysis has, since Freud, developed along a number of different lines: each major psychoanalyst has formulated his or her own approach to analysis that distinguishes itself from Freud's. Psychotherapy, to take another example, is not a single approach to therapy, but rather makes up an entire field. It is the largest and most rapidly growing area relating to mental health. In it are included distinct approaches, such as client-centered therapy, Gestalt therapy, transactional analysis, rational-emotive therapy, existential-humanistic therapy, reality therapy, logotherapy, Adlerian therapy, emotional flooding therapies, and direct decision therapy.

In later chapters, we will look at these approaches to psychotherapy more closely. The goal throughout this book will be to enable you to understand enough about each of the major therapies to make an informed decision in choosing an approach (and there may be more than one) that will be most useful in relation to your own understanding of your objectives, whether they are long-range or focused on the need to eliminate immediate obstacles to growth.

THE DIFFERENCE BETWEEN COUNSELING AND PSYCHOTHERAPY

Counseling and psychotherapy have developed a great deal in recent years—so much so that their boundaries have often overlapped. Clear-cut distinctions between the two fields are increasingly hard to draw. Nevertheless, some professionals prefer to call themselves by one name and some by the other.

In general terms, counseling tends to be a short-term process the purpose of which is to help the client, couple, or family overcome specific problems and eliminate blocks to growth. Counseling gives individuals a chance to resolve personal problems and concerns. Most counselors attempt to help their clients become aware of a widened range of possibilities of choice; from this perspective, counseling tries to free clients from rigid patterns of habit.

Habits can be useful, but they can also interfere with life. The technical habits of a pianist, for example, are essential in performance. Similarly, only when language skills become habitual does a speaker of a foreign language achieve command of it. On the other hand, fears can also become habitual, and they may come to interfere with everyday activities. Anxiety over public speaking may become habitual. There are many personally destructive habits—alcoholism, smoking, over- or under-eating, abusive behavior, shyness and social withdrawal—and all can become self-perpetuating patterns. Counseling can help people break out of these habits, often in part by helping clients become aware of unrecognized alternatives.

Psychotherapy tends to be more concerned than counseling with fundamental personality-structure changes. Frequently, psychotherapy is a longer-term process. Frequently, too, the problems treated in psychotherapy are hard to pin down and are less specific. They include chronic depression, pervasive ("free-floating") anxiety, generalized lack of self-esteem, and so on. Such difficulties are not well defined; their causes may be vague or uncertain, and often much time must be spent to get at their basis. Psychotherapy seeks to bring about an intensive self-awareness of the inner dynamics—the internal forces and the principles that govern them—that are involved in chronic forms of personal distress. Sometimes, as in analytical psychotherapy or psychoanalysis, attention is focused on the role of unconscious processes in inner conflicts; treatment attempts to resolve these conflicts by understanding the unconscious forces involved.

The term psychotherapy is often used to imply more advanced professional training, whereas counseling is something individuals with more modest academic credentials may practice. Whether a professional is called a counselor or a therapist has to do with his or her level of training, with the setting in which services are offered, and, to a certain degree, with that person's theoretical orientation.

In practice, these differences in outlook frequently amount to differences in emphasis rather than approach. In this book, I will speak of counseling and psychotherapy interchangeably unless there is a need to be especially restrictive.

THERAPY: THE ART OF CHANGE

HOW WE ARE ABLE TO CHANGE

We are what we do ... and may do what we choose.
Allen Wheelis, How People Change

Freud identified five causes of personality development:

* growth and maturation
* frustration
* conflict
* inadequacy
* anxiety

By the time we become adults, most of us have developed sets of defenses to enable us to cope with everyday problems in spite of feelings of frustration, conflict, inadequacy, and anxiety. But as these feelings become more pronounced, when we encounter situations that intensify these feelings, we must put more and more energy into our defenses. They allow us to continue living and acting in habitual ways, usually by hiding, by denying, and sometimes by distorting our perceptions of reality.