March 28, 1991

Therapy: Five Cents -The Psychiatrist Is In!

God give me the serenity to accept things which cannot be changed; Give me the courage to change things which must be changed; And the wisdom to know the difference.

Reinhold Niebuhr, 1892-1971

In the old days, when there was a disaster of some kind, after the doctors came the priests. Now it's therapists and counselors. They are supposed to make things better for the survivors. Do they really do any good?

In medicine, there are some conditions that a physician can do something for and others where they can do no good whatever. If you have appendicitis or pneumonia, a competent physician can save your life. If you have a cold, save your time and money. You can do just as well with chicken soup, hot or cold lemonade or whatever makes you feel better.

We all have to deal with the ordinary problems of living. I say ordinary, not to discount the pain that people have, but to point out that everyone who lives long enough, suffers. The problems relate to lovers, spouses, jobs, illness, old age, death, children leaving home, etc. Life, even at its best, is difficult and sometimes very painful.

To make these painful times bearable, you need friends: people you care about, who also care about you. Often, you need someone to tell your troubles to; someone who will listen and not judge you. That's what friendship is all about, acceptance. Often just one good friend is enough. I don't think that lots of friends are anywhere near as good as a few close ones.

There are some unfortunate people who have no friends at all. For them, a therapist will help, but it is an expensive route and it is rarely as satisfactory as friendship; which is a two way street and is paid for in kind. You will do the same thing for your friend when he/she needs it. Like love, the friendship that you pay cash for doesn't hold a candle to the kind that you exchange.

Sometimes people have trouble making decisions; should I change jobs? should I tell my spouse? etc. In these cases, if you really want advice, you want it from someone with wisdom. Wisdom comes with age and experience, preferably in making the same kind of decision that you want to make. Usually, however, it's not advice that a person needs. What he really needs is help in making up his own mind. In this case, a skilled therapist or counselor can be very useful. What a counselor can do is ask the kinds of probing questions that will help his client to realize what he really wants to do. I emphasized the word SKILLED, because a skilled therapist can help you out in a relatively short time, while an unskilled one will beat about the bush, take your money and give you little in return. Often, you can get what you get from a mediocre therapist by talking over your problem with a friend. Sometimes all that is necessary is for a therapist to ask a single key question in order to help you out. The psychologist Bonnie Ring, who used to be on KGO radio, could often put someone on track in less than a minute. While she was doing that, there were other listeners with similar problems who were helping themselves. To do this, a therapist has to be a real expert.

What makes this possible is the fact that we are not as unique as we would like to think. Many people have similar problems. When someone comes to a skilled therapist with severe anxiety, the first questions asked are about their spouse, or what shrinks call "significant others". Better than 9 out of 10 times that zeroes in on the problem. Some therapists prefer to get acquainted before zeroing right in. However, the client is the one who is paying to get acquainted.

Therapists who specialize in marital problems are communications specialists who, if they are to do any good, teach a couple how to talk and listen to one another; to argue without going for the throat. Many a shaky marriage has been helped by a skilled counselor. Counseling with only one member of the pair is like trying to cut something with half of a pair of shears. It rarely helps the marriage and is often a prelude to divorce.

Problems that parents have with children are, likewise, problems of the whole family and are best dealt with that way. I am very skeptical of the effectiveness of individual therapy for children and adolescents.

One dilemma is that a therapist also has to make a living. A minister usually has a salary, while the therapist in private practice doesn't. Some therapists make their living from a small number of chronically unhappy people who have money and can afford to spend some of it on therapy for a muddled life. The therapy doesn't "cure" or "solve" much. He can makes life more-or-less bearable for the client, while keeping himself in groceries. If he specializes in the emotional problems of the rich, he can do a lot better than that.

If a therapist has a conscience, therapy groups will be affordable and, like churches and clubs, will bring friendless people together to their mutual benefit. The friendships made in therapy groups are part of the treatment, and may do more good than the "therapy" itself.

Just as there are sadistic and incompetent physicians, the same holds true for therapists. They are not common. Like any profession, a few are very competent, most are adequate and a few are dangerous. It's a good idea to ask around before picking a therapist. You certainly don't want someone who will drive you from misery to insanity or vice versa.

I suppose that you expect me to answer the question that I asked in the first paragraph: do therapists make things better for people? The answer is yes, they do. Anything that gets people to think, to listen and talk to one another helps.

Is it worth what you pay for it? That's another question, and you only get one answer from me for each nickel.

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