One of the most popular misconceptions about psychotherapy is the near ubiquitous belief among those who are naive to psychotherapy that the primary purpose of therapy is to reassure and thereby lessen anxiety. This belief is perpetuated almost daily on the various talk shows that dependably confirm the victimhood of the publicity hungry sufferers who populate their stage and reassure them of their inherent goodness and right to whatever particular emotional state they currently inhabit. While there is a place for reassurance in Medicine and in Psychotherapy, its wanton overuse is both reflective and reinforcing of a problem.
When a new patient arrives in my office and I begin an assessment, part of what I am interested in is the level of maturity of the person and their ability to tolerate discomfort. For that very small fraction who are unable to tolerate anxiety, sadness, anger without experiencing disorganizing levels of distress, my approach is to first help them establish a more sound platform upon which to support their basic character structure and then proceed to help them find ways to address the weaknesses within them that have created the conditions that led them to my office. Sometimes this includes medications to minimize the danger posed by the tendency to disorganization produced by inherent mental instability (psychosis) or affective instability (serious mood disorders, sever character pathology, neurophysiological vulnerabilities, etc.) Often, I consciously enable the use by the patient of my self as a transference object in order to give the a stable person upon whom to rely when their own abilities to ope are overtaxed. It is rare that I see someone who needs to exclusively rely on such techniques. Most people once introduced to the idea of unconscious ideas and their influence, are able to gain from the active exploration of their own minds, always being aware that if they begin to experience disorganizing or disorienting levels of discomfort, there are ways for us to manage together to deal with the uncomfortable states.
I almost never reassure a patient (and am routinely lambasted for my "cruel withholding" by patients who are sufficiently secure in their therapy, and not yet convinced of its futility, to do so) yet reassurance is one place where our (pseudo)therapeutic culture and our politics intersect, to the detriment of our political discourse and our body politic.
There are several reasons I so rarely reassure, starting with what should be an obvious one: Reassurance never works.
More accurately, although reassurance can allay anxiety for a time, if the source of the anxiety is a real danger or arises from internal and unconscious sources, it will inevitably return, usually in rather short order.
Two examples:
A patient finds a breast lump and makes an appointment for a mammogram. Any woman who did not experience significant anxiety in such a state would be most unusual. At such a time, reassurance that "everything will be all right" is simply the gratification of a wish to be calmed and soothed, as a child is soothed when they are scared and their mommy tells them not to worry. It can work for a child but cannot and should not work for an adult except temporarily. (On the other hand if the reassurance works long term, it may be quite maladaptive; if a friend reassures the woman "everything will be fine" and she accepts that and then cancels her mammogram, there is an obvious problem.) The salient point is that, in fact, everything might not be all right. Most reasonably emotionally sound woman have their mammogram and any follow-up tests necessary, live through the experience with a fair amount of fear and anxiety, and gain some real assurance from a negative test. If such real assurance fails to decrease their anxiety, then we know that there is an additional source of anxiety that needs to be better identified and dealt with.
[This does not at all mean that polite fictions such as "everything will be all right" are always inappropriate. If a friend or family member wants to reassure someone they care about, and in the process reassure themselves, that is perfectly reasonable; usually, all involved understand it as a polite fiction, a form of denial at times necessary so as to function in frightening situations. My job as a therapist however, is not to do what your friends and family can do for you for free.]
Another patient, with a history of abuse, wants to know if her anger is appropriate. In fact, she is filled with rage and it has had an instrumental role in her failed marriage and here depression. Yet, to too many therapists, the therapeutic intervention is to confirm she has a perfect right to her anger and that, in fact, it is perfectly appropriate.
Beyond wondering how I can possibly determine for someone else what level of anger they are experiencing or whether it is appropriate, the reassurance prevents them from understanding exactly how the abuse is effecting them in the present and exploring whether or how their behavior influences their situation. Too many who remain unaware of their own unconscious determinants end up leaving one bad situation only to repeat and recreate the dysfunctional situations and relationships they had just left. ("But he seemed so nice" before it all changed.) I see this time and again in the clinic, where justifying patient's victim-dysfunction as predictable responses to bad situations passes for psychotherapy by too many unsophisticated therapists.
The subtext of both these situations is that when people are stressed they often regress, and in a state of anxiety-provoked regression, the less mature character organization cries out for less mature responses from those who are in a parental position. While reassurance is easy, and in the short term gratifying for both therapist and patient, in the longer run it does nothing to support the person's healthier, more mature self so that they can better adapt to circumstances and deal with difficulties now and in the future.
What does this have to do with politics? Yesterday, although I did not watch or listen to much of the Senate hearings with General Petraeus and Ambassador Crocker (it is a well known fact that watching Senate hearings can induce and accelerate neuronal apoptosis) I did see some excerpts courtesy of Fox News. In the excerpts, a Democratic Senator presented one of the Democratic talking points and a Republican Senator presented the Republican response. The Democrat asked General Petraeus if we were safer for having gone into Iraq, and pre-emptively declared that we are not. The Republican asserted we are safer now than prior to the invasion. There are many variations of this meme. The Left loves to assert that our invasion of Iraq has created more terrorists, an assertion that can neither be proven nor disproven. The Right often wishes to assert we are safer which can also be neither proven nor disproven. Neither side seems to believe they can be honest and say there is no way to know. The Democrats insist on reassurances they would immediately denigrate and would never believe; the Republicans try to reassure the public despite the fact that such reassurance can never work. It would be nice if our politicians on occasion treated us like adults.
Unfortunately, the posturing of the Democrats especially, in contrast to the consummate professionalism of General Petraeus (the most obvious adult in the room), suggests their approach of promoting themselves as the true guarantors of safety (from both real and illusory dangers, including those over which Congress has little to no ability to effect) will not change anytime soon.
All we can say to adults who are interested and concerned, often anxious, is that we have a great many enemies, they would like to kill us, and so far those charged with our safety have been able to protect us. That will just have to suffice; anything else is a sham.
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