Dr. David Rakofsky
You Got a Problem With That? Therapy Can Work Your Issue, Not Just Treat “Pathology”
I overheard a conversation while I was standing in line to order coffee. Two women were talking about work, and one mentioned she was considering a total career change but was struggling with the idea of making such a bold move.
“But I can’t make up my mind,” she said. “Maybe I should see a therapist about it, or is that stupid?”
“It’s not stupid at all,” I chimed in and apologized for eavesdropping. (Therapists aren’t always “analyzing you,” but we’re somehow always listening!). I quickly disclosed that I was a therapist—a psychologist, to be exact—and that my experience has been that such a work-related quandary is often processed within counseling, even when that’s not the reason the client came to me originally.
This anecdote is offered to suggest that therapy is used as an effective outlet for addressing everyday issues and general “stuckness,” not just for treating diagnosable “pathology,” and that it’s okay to work with a therapist on this “Life” stuff. One of the goals of therapy is personal growth and development, and when people come to therapy with an issue, they seek to:
- feel stronger in the face of challenges
- change behaviors holding them back
- examine ways of thinking that affect how they feel
- build relationship skills
- figure out goals
- strengthen self-confidence
- enhance issue-solving skills
Therapy exists to help people sort out issues, overcome or manage deeper pathology, or both things.
Common Psychopathology and Treatments
Approximately 44 million adults in the U.S. experience mental illness in a given year, and 1-5 youths (ages 13-18) experience a severe mental disorder at some point in early life. The most common diagnoses are: depression, general anxiety, panic disorder, and responses to trauma (e.g. PTSD), along with their numerous subsets and variants. Many of these are also seen together and in myriad constellations.
As we’ve discussed in a previous article, the first steps on the path to treatment are receiving an accurate diagnosis and finding the right therapist. There is a range of therapeutic treatments out there--including psychodynamic psychotherapy, cognitive behavioral therapy, and dialectical behavioral therapy, to name just a few styles--and you and your therapist will determine the right fit. Ultimately, patients and therapists work toward the same goal: to reduce or eliminate the symptoms and get to the bottom of their origin. When panic episodes, for example, are disrupting the quality of your life, our role as therapists is to help you gain control of that panic so your world stops narrowing, and to understand what may underlie the panic, too. When major depressive disorder is causing you to disengage with your friends and loved ones, we implement strategies to reconnect.
Sometimes pathology requires a combination of medication management and therapy. In either case, buckle up, because the course of treatment can be protracted through months or years. Real change takes time!
Identifying and Working The Issues
Issues, so to speak, unlike the pathology described above, don't even require formal diagnosis in order to find solutions and to get you on the path of resolution. Often, these issues present as someone exploring an unrealized potential. They tend to be ambiguous and amorphous because they are closely linked to self-improvement. Therefore, goal setting becomes more dynamic from session to session. But to be clear, issues are significant and can be processed and solved in a therapy setting. Among the most common issues to work are Relationship and Career...
Relationship issues run the gamut and vary in size and scope. I work with couples, often younger ones, who’ve arrived at transition points in their lives together. They may be interested in starting a family or having more children, and they utilize therapy to identify and resolve their blocks or clashes around these choices. There are no red flags like lack of affection or infidelity, nor are there visible “symptoms,” disorders, or even dissatisfaction, for that matter. These are just two people wanting a set of ears to help them out of being stuck or stalled.
A popular cohort of mine are men at midlife who’ve reached a point of boredom, dissatisfaction, or lack of stimulation in their current career. It’s not surprising, considering half of Baby Boomers and Generation X employees feel disengaged at work while one out of five is actively disengaged. The latter group complain of more stress and physical pain, have higher blood concentration of the stress hormone cortisol, and high blood pressure, and they are also twice as likely to be diagnosed with depression or to call in sick. They are wrestling with the risks and rewards of making a shift to something else, sometimes at the risk of financial peril. Early intervention, however, is critical to get in front of an issue that eventually devolves into full-on pathology, later.
Pathology and Issues are Often Intertwined
It’s important to note that the reasons for engaging with a therapist aren’t either/or. It can be a mixed bag in that pathology and issues are fellow travelers. We routinely discover that the issues in your life are begotten from pathologies and vice versa. For example, when we’re treating the depression as a primary complaint (i.e., the reason someone made the appointment), we soon learn one of the main stressors is the dissatisfaction or disillusionment in which someone feels trapped. Therefore, creating some solutions to those issues together helps the symptoms of depression and other clinical pathologies abate.
Therapy is for everyone, whether you’re suffering from a diagnosable disorder or just need to solve an issue that is interfering with your personal development and satisfaction. Certainly don’t discount the weight of an issue and do empower yourself by engaging with a therapist to clear a path for your growth.