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That Psychotherapeutic Question: WHY?

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

I have been a psychotherapist for a long time. Many years ago I studied what was thought to be the only type of treatment that worked: psychoanalysis. During the early years of my internship I was often asked that indomitable question, "why" as we explored the many complaints that patients brought to the clinic. Some of the questions were phrased as: "why do I engage in this type of behavior," or "why do I constantly feel this way or that?" My response was often along the lines of "well, we have to explore deeply into your psyche, through psychoanalysis, to find the answers."

When I graduated from my training and was a certified psychoanalyst I believed I was equipped to help patients find the answers to their "why" questions. More than answers, I believed that finding the answers lying in the unconscious would help bring about cure. The trouble is that after I graduated and continued on in psychoanalysis I was confronted by another question posed by patients who had supposed found the answers to "why." The new and even more unsettling question was: "well, so what?"

What was meant by "so what" was that finding the answer to "why" had not resulted in any change. Instead, what did help some people to change was the strength of the therapeutic relationship between me and them. My willingness to show warmth and concern without being intrusive or solicitous seemed to prove some patients with a new interpersonal experience that was healthier than what they experienced during childhood.

As I studied new developments in psychology and psychotherapy I learned to apply cognitive-behavioral techniques to many patients who were not helped by psychoanalysis or psychodynamic psychotherapy. Psychodynamic psychotherapy is based on psychoanalysis without being as deep or as long term a procedure as analysis. Cognitive-behavioral therapy (CBT) provided a tool for patients to learn how to help themselves in the present without worrying about the past or about the question "why." As patients learned how to apply CBT to their anxious and depressive feelings they started to feel a lot better about themselves and their lives. In fact, when some of them once again brought up the question of why these things had happened to them they found it relieving to not have to worry about that question but how to modify thinking patterns so that they could feel better.

I do not mean to suggest that psychoanalysis is a failure or that "why" is an unimportant question. My point is that the answer to "why" may be interesting and even helpful to patients but does not represent a cure. In fact, it has been my experience that some patients become very confused by that question. In the end, a psychotherapist, like a good practitioner of any kind, must adapt their approach to the needs of the patient. CBT and Dynamic therapy are useful tools that can help patients function more successfully in their lives.

Keep Reading By Author Allan Schwartz, LCSW, Ph.D.
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