Oliver Burke­man

Why as­sume ther­apy is harm­less? Plus My life in sex

The Guardian - Weekend - - News -

“Get help and get happy!” runs a tagline for one of the new gen­er­a­tion of e-coun­selling ser­vices, of­fer­ing psy­chother­apy by text, phone and video chat. Ex­cept it turns out that get­ting happy is by no means guar­an­teed to be ther­apy’s only out­come. One re­cent pa­per (which I found via the ex­cel­lent Re­search Di­gest blog) es­ti­mates that, when it comes to cog­ni­tive be­havioural ther­apy, 43% of clients will ex­pe­ri­ence un­wanted side-ef­fects like dis­tress, a de­te­ri­o­ra­tion in their symp­toms, or strained fam­ily re­la­tions. “Psy­chother­apy is not harm­less,” the pa­per’s au­thors con­clude. It’s use­ful re­search. But that con­clu­sion high­lights a wide­spread be­lief about ther­apy that gets stranger the longer you dwell on it: why on earth would any­one as­sume it was harm­less in the first place?

There are echoes, here, of the sur­prise that greets me­dia rev­e­la­tions that mind­ful­ness med­i­ta­tion – an­other seem­ingly guar­an­teed path to hap­pi­ness – has its per­ils. Be­gin­ners, es­pe­cially if they’ve ex­pe­ri­enced trauma, some­times re­port emo­tional “flood­ing”: once they turn their at­ten­tion in­wards, and fol­low the in­struc­tions to no­tice their emo­tions with­out judg­ment, they’re en­gulfed by thoughts and feel­ings they’d pre­vi­ously been keep­ing in check. (Re­pres­sion may not be the health­i­est tech­nique for deal­ing with trauma, but it can be a prac­ti­cal way to get through the day.) Ad­vanced med­i­ta­tors, mean­while, oc­ca­sion­ally re­port distress­ing ex­pe­ri­ences of panic or mean­ing­less­ness known as the “dark night”, a re­sult of fun­da­menta fun­da­men­tally rewiring their per­cep­tion of re­al­ity.

Yet if ther­apy thera and med­i­ta­tion weren’t po­tent enough to ha have such ef­fects, would they be any use at all? A ham­mer ham strong enough to drive a nail into a wall must als also be ca­pa­ble of crush­ing your thumb. It’s not that t the ben­e­fits of these psy­cho­log­i­cal in­ter­ven­tion in­ter­ven­tions are ex­ag­ger­ated; rather, it’s that they de­pend on their th reach­ing deep in­side your mind and mak­ing sig­nif­i­cant pos­i­tive changes there – which means they could make neg­a­tive ones, too.

No­body doubts this when it comes to chem­i­cal in­ter­ven­tions: the fact that an­tide­pres­sants can be trans­for­ma­tive for many peo­ple is in­sep­a­ra­ble from the fact that for some they make things worse. Like­wise, chang­ing your diet can bring a big boost in hap­pi­ness – or a big de­crease, if you switch to junk food and vodka. It’s only with di­rectly psy­cho­log­i­cal in­ter­ven­tions, ap­par­ently, that we’re as­ton­ished to dis­cover the up­side has a down­side.

One fi­nal co­nun­drum, the study’s au­thors ob­serve, is what should count as a neg­a­tive side-ef­fect any­way. Ac­cord­ing to many mod­els of both ther­apy and med­i­ta­tion, some de­gree of dis­tress proves the process is work­ing – as Robert Frost put it, there is “no way out but through”. Con­fronting psy­cho­log­i­cal pain is, well, painful. (The study even in­cluded up­set­ting re­la­tion­ship breakups as a side-ef­fect, but it’s easy to imag­ine cases where a breakup would be a great re­sult.) This in turn sug­gests that maybe “get­ting happy” isn’t the best way to think about the aim here. Maybe con­fronting life as it re­ally is – even when that’s no cause for cel­e­bra­tion – is the path to mean­ing.

I re­main par­tial to Sig­mund Freud’s re­mark that his goal was chang­ing “neu­rotic mis­ery into or­di­nary un­hap­pi­ness”, a tagline I don’t ex­pect to see grac­ing an e-ther­apy web­site any­time soon

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