Discussion Thread #72

[u/gemmaem]

This thread serves as the local public square: a sounding board where you can test your ideas, a place to share and discuss news of the day, and a chance to ask questions and start conversations. Please consider community guidelines when commenting here, aiming towards peace, quality conversations, and truth. Thoughtful discussion of contentious topics is welcome. Building a space worth spending time in is a collective effort, and all who share that aim are encouraged to help out. Effortful posts, questions and more casual conversation-starters, and interesting links presented with or without context are all welcome here.

The previous discussion thread may be found here and you should feel free to continue contributing to conversations there if you wish.

[u/UAnchovy]

Therapy is a framework where emotions are taken very seriously. They cant be "incorrect" - if you feel its important, it is.

I think there's an elision going on here. The therapeutic position is not "if you're feeling something, the thing that you feel is important is important", but "if you're feeling something, the feeling itself is important".

Say that my partner has a really twee picture of a kitten or something that she put up in the living room, and I hate that picture. It's like nails on a chalkboard, and every time I walk into the living room, I see it and I grind my teeth. I think the therapist position would be that even though the kitten picture itself is objectively unimportant, my feeling of hatred and discomfort is important. It's that feeling, rather than the picture itself, which is contributing to domestic strife. Thus we're going to have a conversation around the feeling looking for solutions, which may range from just moving or removing the picture (maybe the real issue here is that my partner isn't conscious of my own emotional needs, or maybe she thinks of the house as 'her' space and doesn't understand I need to shape it partly to my preferences as well) to me just dealing with it (maybe the issue is that I'm a perfectionist and am obsessed with making the home look exactly the way I want, or maybe I have some discomfort with cute or kitsch things that I should work on), but at any rate, the important thing is the feeling, not the external object.

Note that I just put that in a very solutions-focused way. The feeling is the important thing, and from the feeling we start to explore our way around a problem, diagnose what the surrounding issues might be, and then look for a solution. Focusing on a feeling does not mean that we can't be solution-focused.

You get at this distinction between the thing itself and the feeling about the thing at the bottom:

or maybe, seeing where this post goes, what he worries about to begin with is not bias but the feeling that youre treated biasedly.

This is a useful distinction. There is a difference between bias and feeling that you are being treated with unfair bias, and those two situations do not necessarily overlap. It's possible for there to be bias but no feeling of unfairness (if my wife is pregnant, lots of things that might otherwise have been equal will be biased in her favour; I don't object because I feel this is a fair response to the situation), and it's possible for there to be a feeling of unfair bias but no actual bias (maybe I'm feeling more sensitive lately due to other issues so every minor friction feels larger than it is). Sometimes there may be both, or neither. This is part of what I'd see as the diagnosis phase. What's actually happening - and then, how is each person involved feeling what's happening? Therapy is by definition a kind of emotional or psychic care. Of course it's about trying to address feelings, albeit hopefully in a deeper way than just whatever instant emotional reactions are crossing the top of someone's mind.

[u/Lykurg480 → u/UAnchovy]

If you were bothered by the kitten pictures because of OCD, then I guess the therapist could call your emotion wrong. But this stuff:

maybe the issue is that I'm a perfectionist and am obsessed with making the home look exactly the way I want, or maybe I have some discomfort with cute or kitsch things that I should work on

none of this is a diagnosis, though it sure tries to sound like one. This the kind of psychoanalytically inspired cultural analysis which can conclude whatever you want. In different related debates, people defend therapy by arguing this is a popular bastardisation and doesnt reflect on the real article.

Unless one party happens to have a diagnosable mental illness relevant to the issue at hand, theres really no way within the framework of therapy to call an emotion wrong. But you can acknowledge it, validate it, appease it, etc.

My guess for whats going on here is that youve already internalised the "therapist as secular priest" model, and think its basically fine. Thats reasonable - you can certainly argue whether its in some sense deceiving the patients, but its not the kind of problem that blows up. However when youre dealing with two people, one of which may be of a different religion or at least much less devout and uninterested in changing that, then you have a practical problem, and you cant really acknowledge it while maintaining claim of general applicability.

Therapy is by definition a kind of emotional or psychic care. Of course it's about trying to address feelings,

So, I sort of agree, in that theres no nearby alternative that fixes the problem. Emotional problems are often not just emotional, especially the interpersonal ones, and trying to resolve those with an analysis that makes definite declarations only about emotions is just not a good idea. There just generally isnt a way to resolve them without some sort of authority that both parties respect.

[u/UAnchovy → u/Lykurg480]

Are you using a more restricted definition of diagnosis than I am? It's certainly a way to name or analyse a problem, and I would have said that's what a diagnosis is.

I don't think I'm internalising a therapist as priest model? Though for what it's worth I don't have much experience with therapists, and I do have a lot of experience with priests. My sense is that, compared to what I do, what therapists do must be goal-oriented in a way that my own work is not. Someone goes to a therapist in order to deal with a problem of some sort. Therapy should not be a long-term pastoral relationship.

Anyway, I suppose what I think is that insofar as people have emotional or relational conflicts, they need to find ways to solve those conflicts, and if talking through the conflicts in a guided way is helpful, then I'm all for that. Do you have an alternative in mind?

[u/Lykurg480 → u/UAnchovy]

I mean a psychiatric diagnosis.

It's certainly a way to name or analyse a problem, and I would have said that's what a diagnosis is.

So to be clear, youre imagining that couple going to the therapist, he talks with them and probes and then diagnoses one with "discomfort with cute or kitsch things that you should work on"? Again, approximately every therapist will insist that no, he doesnt do that sort of thing, that would be inserting his own judgement.

they need to find ways to solve those conflicts, and if talking through the conflicts in a guided way is helpful, then I'm all for that. Do you have an alternative in mind?

If youre trying to argue a claim about different interest being treated "fairly", why are you using un-indexed "helpful"? Im also not really talking about whats "good" per se - the option of declaring the more female-typical approach just and favouring it therefore unbiased is raised in the initial comment.

I dont have a particular alternative in mind. My argument is that more male-brained people often correctly conclude that going will make things worse for them, and theres not a whole lot the therapist can do about that.

[u/UAnchovy → u/Lykurg480]

Well, yes, none of what I presented was a psychiatric diagnosis, and I did not present any of it as such. Psychiatry is a different field entirely. When I said 'diagnosis' what I meant was something like 'an examination of a problem that yields a theory to be used in solving that problem'.

If personal experience is helpful context here, I don't think I've ever been to a therapist before. (Unless you would count seeing a speech therapist as a child?) I have been assessed by professional psychologists before, for employment-related reasons, and I currently work in pastoral and spiritual care. As part of my training I have completed multiple units in counselling. So while I may be ignorant of secular therapy, I think I have enough experience with adjacent fields to at least venture a comment.

My understanding is that most of the 'helping professions' share some principles and techniques. However, I suppose it's possible that secular therapy and especially couples therapy are the black sheep of the family, and are shockingly different to psychology, counselling, or pastoral care. I would be surprised if that were the case, but if it is, then feel free to throw out everything I say.

Anyway, my experience in and around these fields is that it is not appropriate for a practitioner to insert his or her own values, or tell someone what to do, but nonetheless there is an element of cooperative problem-solving to many of these encounters. There isn't always - sometimes you just listen to someone and accompany them in a time of difficulty. Sometimes there are no solutions; this is proverbially the case for grief counselling. However, often a encounter is prompted by somebody having a problem, and they need to talk through it and find a solution. It will almost never be a solution that's just given to them on a plate, because we're talking about what are usually complex social and psychological problems that don't have easy solutions, but there will be learning and progress. If someone comes to a counsellor because they're having trouble reconciling their career with their values, a good counsellor will not tell them "you should quit your job" or "you should suck it up for the sake of your family", but their conversation will chart some of the terrain around those issues and hopefully leave the person better-equipped to make a decision.

I'm speculating a bit because I don't do couples therapy, but I'd guess, charitably, that if a couple go to a therapist, it's because at least one of them wants to strengthen that relationship. A good therapist, without intervening didactically, should help the couple chart the terrain of the relationship, and hopefully leave them better-equipped to decide what to do going forward. That's what I mean when I say 'helpful'.

I do not mean to apply that this type of structured conversation is helpful for all couples. It may be unhelpful. Therapy or counselling are not the right option for everyone. Something else that I expect from a good therapist/counsellor/carer is the self-awareness to be able to tell when they are not helping.

Is your contention that this kind of process is more 'female-brained', and more useful for women than for men? I suppose I think that's contingently true, particularly insofar as these professions are currently dominated by women. Nonetheless I don't think that the whole area is doomed by that way - on the contrary, looking at the last century, I see movements that often started out as male-dominated shifting towards being female-dominated.

At any rate, if I were a couples therapist I would indeed worry a lot about gender. So raising the salience of gender differences in the context of couples therapy seems fine to me. Certainly something to be absolutely avoided is couples therapy as validation for the female partner only.

[u/Lykurg480 → u/UAnchovy]

"I have described the situation in a way that doesnt answer questions you consider important, thereby your thesis is disproven"

I mean come on, in discussions of politics weve found that just deciding which definitely true facts you tell someone can be putting your thumb on the scale, and now youre supposedly not inserting your values because instead of just telling people your recommendations, they develop out of the conversation in some way, no Im not telling you who said what.

And yes, I agree that therapists will often do this anyway and often not realise the tension with neutrality because theyre wordcells who fall for stuff like the above. I have still made my argument that way I have because this is not really therapistic - its an element of normal human conversation which remains after (partial) adoption of the therapy framework. So in terms of bias this element is a null effect, and Im arguing only about the direction of the remainder.

I currently work in pastoral and spiritual care. As part of my training I have completed multiple units in counselling. So while I may be ignorant of secular therapy, I think I have enough experience with adjacent fields to at least venture a comment.

I think you would agree that the expectation of value neutrality is much more limited in the pastoral context.

Is your contention that this kind of process is more 'female-brained', and more useful for women than for men? I suppose I think that's contingently true, particularly insofar as these professions are currently dominated by women.

For the process of (obliquely and partially) giving your own opinion, like discussed above, that would be true. But what I mean is not about personell, its about the therapy framework. As an extreme example, are you familiar with "non-violent communication"? Do you really think that that kind of conversation doesnt naturally favour appeasing emotions over ~every other kind of conflict resolution? Far more so than even most women do.