What are the key ingredients in therapy that works in difficult situations? Fact and reason? Or a therapist willing to be with the client in the darkest places where we humans have to admit that we don’t know what the point is, and that we cannot fix it?
I am a great fan of not knowing, or, as John Keats put it in 1817, “Negative Capability [...] when man is capable of being in uncertainties, Mysteries, doubts without any irritable reaching after fact & reason”. In 2008, we even could add “or woman”!
I am more and more convinced that this is the key quality needed in good therapists. Of course there needs to be good communicative contact, trust, empathy, realness and all the rest of it for any therapeutic relationship to be possible at all. But when there is contact, trust, empathy, unconditional respect and realness, I am not as convinced as Carl Rogers, founder of Person Centred Therapy, was that this will inevitably produce the desired “therapeutic movement” or real, positive change in the client’s life. I can agree that with all these factors present there has to be some movement, as being accepted and listened to and respected are such powerful things.
But when the situation is complicated, the most accepting counsellor may be unable to really go into how the client works, inside, if they have got that “irritable reaching after fact and reason” bad! While respecting the client and understanding in a broad sense the emotions they are experiencing, they may be unable to get to the root of what the client experiences simply because they have their own overriding need to make it fit into a sensible framework for them. The itching after facts can be quite unbearable, I know from experience. As a therapist by definition you hear only one side of the story. By definition, too, every story has many sides.
Of course, before you all think I am a well meaning and totally ineffectual therapist trying to deal with serious mental health issues with a good dose of nineteenth century poetry (who, me?) I must state that very often fact and reason are exactly what is required. Someone who suffers panic attacks needs to know how they work and that they are not life-threatening. Someone who has been abused as a child needs to know that it was not their fault. People who have suffered domestic violence need to know that they are not the ones who are crazy. Etc. Sometimes facts and reason, in a context of respect and understanding are all that is needed to move people on. In fact, even facts read on the internet may be enough to do the job, if the person is ready to take them in. The directions in which therapy is currently moving seem to me to work on the basis of facts and reason — researching for example what kind of techniques allow people to understand what they believe and think and how this influences their behaviour.
But what I am arguing is that supplying facts and applying reason to situations within a respectful relationship is reasonably easy to do. Whereas people who are suffering from thoughts and feelings that they cannot come to terms with or make sense of, and the feeling of isolation and/or craziness that goes with the territory, as they can’t even explain them to people properly, these people need a therapist who can do a little more, someone who is willing to dive right into the mess with them and take it on its own terms.
Someone who has suffered various losses, tragedies, torture, or ‘just’ an inexplicable depression, may well find themselves in a place of uncertainty, mystery and doubt. People in these situations are unlikely to be fundamentally helped by therapy which teaches them or enables them to function better. Their point is, yes OK, I can get through the day, but why should I? What is the point?
If the therapist can actually meet the client where they are, rather than trying to explain or comfort it away or simply ignore that most painful and pressing of the clients’ experiences, then I think there is hope of the client being able to access their own resilience and their own way of making meaning, and ultimately find their own way out.
Facts and reason are indispensable but they have their limitations. It is hard to see how they are going to help, for example, someone whose child gets killed in a freak accident. Sympathy by itself is not going to help much either. But when somebody else is not afraid to go into those nasty regions of human experience with you, and ask all the impossible questions along with you, there may be no guarantees, but, the way I see it, there is hope.