Good therapy. I love these two words. In fact, to me they sound just as good in reverse. In either direction, it’s a mark I try to hit every time I sit down with a person interested in change. Sound too simplistic? It is and yet it isn’t, and that my friend is what’s known as a paradox. On the surface, people seek therapy for a multitude of different reasons, all of which are really the same reason: Something has to change. Every person who has ever visited my office is there to change something. The what and how are sometimes different, but at base, therapy is about nothing more than creating change. This humble objective is a good thing because after twenty plus years of doing this work, I’ve killed any illusions about who and what I am as a therapist. There is no magic in my words. I’m not privy to any particular wisdom about how people should live their lives. I’m not measurably better than anyone else when it comes to giving advice and when one of my clients has a successful experience, it’s almost assuredly more about the work they have done than any I’ve done.

So, if we can accept that the premise of psychotherapy is to change something, where does mental health fit into the picture? This is a worthwhile question and it’s here you’ll find I part ways with many of my colleagues. It’s important that you to know that some of the things I have to say on the subject are not always popular among my peers in this field. The mental health field is stuffed with hardworking people whose compassion is evident by the fact they show up every day willing to hold enormous responsibility and risk at levels nearly always out of proportion to the financial reward received in return. It’s an industry filled with earnest pursuits and honest efforts. Counselors, therapists, social workers, and facilitators of all things psychological routinely demonstrate courage and toughness. These are perhaps plain virtues, but people working in mental health have them in spades. But these virtues, while necessary, are not alone sufficient to the task of making good therapy happen nor do they hide the fact that we in this industry are too often our own worst enemy. We understand more about mental health and why therapy works than at any other time in our history, but we consistently fail to use that information. Therapists often have difficulty with this criticism and I believe that reveals a problem. We have built a system responsible for its own shortcomings but simultaneously lacking in the same introspection we expect from the users of our services. I call it smartest guy in the room syndrome and therapists are often among the worst offenders. This kind of clinical arrogance has a measurable downside. For example, how is it that therapists, people who presumably should know better, overuse words like “trauma”, “bullying” and “abuse” with seemingly no awareness of how doing so dishonors those who have endured circumstances worthy of the definitions? I distrust such an unspoken investment in human fragility. It creates an aspect to our field that feels a little too much like ambulance chancing and it undermines our credibility. And the longer I work, that harder it is for me to find a comfortable fit inside this world.

I try to provide treatment based on the basic principle of “do what works”, and this first means we build on those things you already have going for you. If you are considering some kind of counseling or therapy for you or your teen, look for a person who sees strength first.


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