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I’m not exactly sure why, but the majority of my patients seem to require long-term psychotherapy (1 year or more of psychotherapy). On rare occasion (probably 20% of the time), treatment can be completed in less than 12 sessions. Perhaps it is the nature of the referrals I receive. The problems tend to be more complex and at a personality level. But perhaps it is that the prevalent paradigms for psychotherapy are not interested in the best possible outcome. I don’t really know yet what the answer is.
But I do know, that recent research1, shows that long-term psychodynamic treatment is the best approach for complex problems. And it also seems to me that a vast majority of my patients have complex problems. What I am uncertain of, is “Do I see problems as being more complex than other psychotherapists?” or “Do I see patients with more complex problems than the average psychotherapist?”
Regardless, what I do know is that I have done absolutely no advertising in a town of less than 10,000 people. One of my biggest referral sources is a bar in a town 45 miles away (that I have never been to). All of my recent new referrals have come from this bar. The comment from my new patients is, “I know you treated ‘Jane,’ she had a lot of problems. I thought to myself, ‘If she can change, I can too. I saw all of the changes that she made, and I was amazed.’” The patients talked to each other and started car-pooling to get to sessions with me. Other than one individual, their problems were very complex, requiring long-term treatment (treatment duration greater than 1 year).
So, on average, I’ve seen longer-term psychotherapy have great outcomes. Along the way, there have been a few short-term treatments with great outcomes. But on average, “Longer treatment is better treatment.”
On occasion, probably 10% of the time, treatment is a failure. The patient drops out without completing treatment, and continues to have problems. This percentage is fairly subjective, but I think it’s a fairly accurate representation. I’d like to get this down to 1 to 5%, and feel that this is possible if I can get better at my job. I think the main point I’m trying to get across to you, is that long-term treatment may be one of the best solutions to many problems that folks have.
1 http://www.sciencedaily.com/releases/2008/09/080930164454.htm
Everyone doubts themselves from time to time. And at major life transitions, doubt is an extremely common thing. When a child goes from junior high to high school, they doubt themselves. When a high school student transitions to college, they doubt themselves. When a child attends a new school, they doubt themselves. When you get a new job, you doubt yourself.
But for some people, they have deeply rooted feelings of defectiveness. And it’s not technically correct that they “feel” defective, but rather that they think they are defective and that results in a number of different emotions (sadness, shame, anxiety, anger). For some people, their whole way of seeing what happens in the world is organized around their beliefs that they are defective. Jung developed the notion of a ‘complex’ that was later also used by Freud. More recently, the notion of a ’schema’ has arisen from cognitive therapy (or Schema Focused Cognitive Therapy), which has many similar characteristics to a complex.
A complex is described as “In Jung’s use of the term, a complex is literally a grouping of parts around some central emotional theme. For example, if you had a leg amputated as a child, you might develop a complex about it. Your complex might involve all the thoughts and emotions built up over a lifetime about the absent leg and the impact it might have had on people’s reactions to you, your opportunities in life, or anything else relating to the amputated leg. Unlike Freud, Jung did not assume most of these complexes were sexual in nature. A complex was due to some twist or turn in life that had a big emotional impact on a person.” (1)
A schema is described as “a mental structure that represents some aspect of the world. This learning theory views organized knowledge as an elaborate network of abstract mental structures which represent one’s understanding of the world. Schema theory was developed by R. C. Anderson, a respected educational psychologist.” (2)
In the Bible, it explains that,
“9(H) That which has been is that which will be, And that which has been done is that which will be done. So there is nothing new under the sun. 10 Is there anything of which one might say, “See this, it is new”? Already it has existed for ages Which were before us.” (3)
Psychologists often lose this perspective on things. But the fact of the matter is, most often, they are just using different words to describe things that have been observed by others. They feel important for their ‘ground breaking’ discoveries, but all they have really done is re-label concepts that have been explored and understood by others. The Last Psychiatrist would call this narcissism.
There are a number of ways that a person may develop a defectiveness complex. Problems with motor skills, problems learning how to walk, problems with a sensory system (such as vision or hearing), learning disabilities, and other problems that may occur during childhood. Sometimes there is an early severe fever that results in motor or learning problems. Sometimes there is an acute physical problem. Regardless, it is something that must occur early in life. What tends to happen is that all subsequent things that happen are filtered through this ‘complex’ or ’schema’ and are seen by the person as supporting the fact that they are defective.
I remember one woman who developed Rocky Mountain Spotted Fever as a child. As a result, she was uncoordinated and clumsy. So, she was constantly reminded of the fact of her ‘defectiveness’ by bumbling clumsiness. Subsequently, all things that happened in her life were filtered through this belief and frame of reference. She never had the confidence to ask for a raise, or seek a job that was consisent with her true abilities. She never had any luck in relationships because she expected others to discover that she was defective, and drove men away because of this. All of these things were seen as just more evidence for her defectiveness. Now, the person doesn’t usually have a conscious awareness of how this developed. But unconsciously, it influences how they interpret things in their lives, what they remember from the past (their personal failures), and their expectations for the future (continued failure, rejection, etc…).
These difficulties often take several years of treatment in order to resolve. The ‘complex’ or the ’schema’ is well defended within the individual and extremely difficult to challenge. The individual often develops information supporting their notion that they are defective despite any evidence to the contrary. The explanation that this is a ‘complex’ or ’schema’ often helps the indvidual come to the realization that their view is distorted based on beliefs that were developed through early life experiences. Once they develop this insight, they can begin to understand and change the ‘complex’ or ’schema’ that has been so self-limiting in their lives.
Interestingly, the notion of a ‘complex’ was developed by Carl Jung (a psychoanalyst), and the notion of schema-focused cogntive therapy has been expounded by Jeffrey Young 
Although I’m not keen on some of Jung’s notions (such as the collective unconscious and archetypes), I’m not one to ‘throw the baby out with the bath water.’ I have to largely agree with the following statement from Jung, “The patient who comes to us has a story that is not told, and which as a rule no one knows of. To my mind, therapy only really begins after the investigation of that wholly personal story. It is the patient’s secret, the rock against which he is shattered. If I know his secret story, I have a key to treatment.” (4) I find this to be exactly the case in treatment with my patients. My mentor likes to quote the old proverb:
“For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.”
In treatment, I try to find the nail. Once the nail is found, the battle is won. It’s not necessarily won right at the point that the nail is found, because we have riding, battle, and defense of the kingdom left, but it is the pivotal point around which the treatment revolves. There are many reason’s which people come to feel defective, and the discovery of this reason is the nail which leads to the ultimate success of treatment. And, I think the notion of war is appropriate to psychotherapy. It’s a war against the emotional difficulties of the patient, and often entails numerous battles. Sometimes, the enemy is more easily vanquished, and other times, the battles are ongoing and intense. So, God be with you, in your own battles.
Remember the verse from the Bible, “I can do all things through Christ who strengthens me.” (5) You may well need this strength to win your battle. But, I believe in you and the power of God, as I believe in my patients. Fight the good fight, and keep working hard to get to a better place in your life.
(1). http://www.psywww.com/intropsych/ch13_therapies/jungian_therapy.html
(2). http://en.wikipedia.org/wiki/Schema_%28psychology%29
(3). Ecclesiates 1:9-10.
(4). Jaffe and Jung
(5). Philippians 4:13
“Freud saw psychology as a scientific replacement for religion. Psychological theory replaces outmoded religious beliefs about the human person. And psychoanalytic techniques replace religious practices.” (1)
Freud noted that the, “analysis is not complete” until the patient’s religious views were analyzed. I agree, but in the opposite way that Freud envisioned.
There are often clear psychological reasons that a person becomes an ‘atheist.’ Most often, the thing that gets in the way of faith, is the relationship with the individual’s father. Specifically, if the father was harsh and cruel, the individual will often come to impute or displace these characteristics onto God. They will often see God as “harsh and cruel.” The father doesn’t necessarily have to be harsh or cruel, there can be many factors and varieties of the problematic relationship.
“God can’t exist because there is evil in the world.” Many atheists come to believe that there is no God, because of the fact of “evil” in the world. And, that if there is a God, he must be cruel because of the bad things he allows to happen (murder, rape, natural disasters, and so forth).
I’ve heard it said, “If there was a God, then why do so many bad things happen to good people.”
They can’t conceive of a “heavenly father,” who loves them and who cares about the world. They ‘project’ their feelings toward their earthly father onto God. They believe that there is such a thing as “good people.”
So far, I have not seen a single atheist who does not have relationship problems with their father. Or often, if they believe, their belief is distorted by their relationship with their father. They project (direct or displace) their feelings toward their father onto God.
I’m not saying that this is the only psychological reason that one becomes an atheist, but it is the one I have observed frequently.
It’s interesting to look at Freud as an example.
In his 40s, Freud “had numerous psychosomatic disorders as well as exaggerated fears of dying and other phobias” (Corey 2001, p. 67). During this time Freud was involved in the task of exploring his own dreams, memories, and the dynamics of his personality development. During this self-analysis, he came to realize the hostility he felt towards his father (Jacob Freud), who had died in 1896…(2)
Charles Darwin is also noted as having a problematic relationship with his father. In the course of researching for this post, I discovered that I am not the first to connect the idea of problematic relationships with the father and atheism. It turns out there is a book entitled, Faith of the Fatherless: The Psychology of Atheism
Many times, I have seen patients resolve their emotional conflict about God in the context of their feelings toward their fathers. When they come to see that they have displaced their feelings toward their earthly fathers onto the heavenly One, they are often able to develop a relationship with God, without the emotional baggage.
(1). http://www.jcu.edu/philosophy/gensler/RE/R-F2–00.HTM
(2). http://en.wikipedia.org/wiki/Sigmund_Freud
See also, Some Psychological Aspects of Atheism Part II and Part III, and Since atheists are about the only ones responding to my post.
Emotions are expressed one way or another. They are either expressed directly, or indirectly. In graduate school, they teach that the cathartic theory of Freud is completely incorrect with respect to anger. In other words, they teach that expressing anger always increases anger problems. While they are right for people who have genuine problems with managing their anger, they are incorrect for people who “over manage” their anger. Some people learn that anger is dangerous, prohibited, wrong, and should not be expressed in any direct way. As I said before, they way that people express their anger is largely learned.
People who overmanage their anger tend to be anxious, and/or experience a number of physical difficulties (pain, headaches, worries, obsessive thoughts, compulsions). One of the roles of anxiety is inhibition. It inhibits aggressive impulses. I have seen a number of people become socially anxious as they begin to manage their anger more appropriately. This social anxiety serves a positive purpose, and that is to inhibit the expression of anger. People may experience several years of social anxiety as they learn different ways to express themselves appropriately. I don’t try to take this away when it occurs, because I recognize the beneficial purpose. That is, inhibiting agression. A person often has to learn how to express themselves in appropriate ways in order to overcome a significant anxiety disorder.
That said, when a person feels anxious, there is often an unconscious anger component. When this component is identified, the person no longer feels anxious. The fact of the matter is, a person cannot feel anxious and angry at the same time. They are incompatible emotions. The idea of cathasis was around before Freud, but I will focus on the the famous case explored by Breuer and Freud…Anna O.
It was eleven years later that Breuer and his assistant, Sigmund Freud, wrote a book on hysteria. In it they explained their theory: Every hysteria is the result of a traumatic experience, one that cannot be integrated into the person’s understanding of the world. The emotions appropriate to the trauma are not expressed in any direct fashion, but do not simply evaporate: They express themselves in behaviors that in a weak, vague way offer a response to the trauma. These symptoms are, in other words, meaningful. When the client can be made aware of the meanings of his or her symptoms (through hypnosis, for example) then the unexpressed emotions are released and so no longer need to express themselves as symptoms. It is analogous to lancing a boil or draining an infection. (1)
Now, what I have found is catharsis only works with repressed emotion. Those emotions that are blocked from awareness. This doesn’t work with people who have insufficient repression (aggressive individuals). This works with individuals who inhibit or block awareness of their emotions. Academic researchers have overgeneralized from research that show that for angry individuals expressing anger…they become more angry and practiced at expressing their anger. However, in my experience, cartharsis applied to emotions that are blocked from awareness through repression….it resolves the symptom.
Most often, people need to learn that it is ok to say “no” and to express that they are angry. This is for people that have learned that anger is unacceptable. Once they learn this, there is often a reduction of anxiety and psychophysiological complaints that take the place of the expression of anger.
(1). Retrieved from wikipedia (http://webspace.ship.edu/cgboer/freud.html).
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