The 3 Helpful Components of Therapy, according to David Smail.

[Evan2435]

Hello everyone. I'm new here, but glad to be a part of this community and hope I can make some meaningful contributions.

Some of you may be familiar with the British clinical psychologist, David Smail. He practiced psychotherapy and was very honest about its limitations. His books are also an excellent resource.

I'd like to outline, in David's view, the three components of therapy that are (potentially) useful.

Component #1: Explanation

People enter therapy because they know they are in pain and feel helpless as to what to do about it. Psychological distress is perhaps a matter of extent rather than kind, and in situations where someone is unable to pinpoint the reasons for their distress, or the people in their lives are somehow implicated in, ignorant about, or overwhelmed by it, it is unlikely that they have access to any form of objective advice.

A therapist is in a rather unique position. While they can't, in good faith, make any claim to their services being of a "technical" nature, they do talk to so many people that they often begin to notice patterns in the types of things that usually cause a person distress. These aren't things that a fairly sensitive, empathetic, or observant person can't understand if they talk to someone long enough, but in some cases a therapist may be the only person someone has access to who may be able to provide a fairly accurate explanation. A therapist may point out concerns that a partner, friend, or parent's behavior is abusive, and so on. 

In an ideal world, a therapist would acknowledge that they hold no "expert" knowledge, and work with the client in a process of negotiation to determine the causes of the person's distress, whether that be past or present (in most situations, I would assume, it is both). However, most therapists are unwilling to acknowledge the untechnical nature of this process despite the fact that this is likely what most therapists find themselves doing on a regular basis. While an explanation certainly does nothing to solve the issue, it may make it more clear to the client what can be done to relieve some of their distress if they have the power to do so. 

Component #2: Comfort

This is probably what therapists find themselves doing most often, and it makes sense. Even if the therapist can't solve the issue for you, they can provide a place in which you can go to vent about your issues for 45 minutes each week. It's a poor substitute for real social support, but as long as you keep paying, it's pretty much there. For a fee, you can have the attention of an individual who will remember seemingly trivial things about your life, "interpret" what you say, and (at least to you) appear to take an active interest in your life.

Component #3: Encouragement

Once you identify the issue that's causing your distress, a therapist may be a source of encouragement in tackling the issue. This in of itself will do nothing to relieve you of the social constraints which cause the issue in the first place, but, much like comfort, it may be therapeutic in facing life's difficulties.

 

This is all in an ideal world, of course. Most therapists are too wrapped up in the psychotherapeutic theories to which they give their allegiance to ever consider that their job is akin to being a paid friend or an emotional prostitute. In my case, it was the therapist who was emotionally abusing me, and I had no idea. The therapist couldn't have provided me with the explanation. It was my girlfriend who did so. Once I stopped going, I found that my mental distress lessened considerably and I resumed being able to cope with life. 

Edited April 28, 2021 by Evan2435

[Mary S]

Unfortunately, "David Small" is a common name, so it would be helpful if you could give a reference to the David Small you are talking about. I am guessing that it is the one whose obituary is here .

 

 

[Mary S]

i have some concerns with your Component #1 (Explanation).

15 hours ago, Evan2435 said:

A therapist is in a rather unique position. While they can't, in good faith, make any claim to their services being of a "technical" nature, they do talk to so many people that they often begin to notice patterns in the types of things that usually cause a person distress.

I also have some concerns with your comment, "A therapist is in a rather unique position. While they can't, in good faith, make any claim to their services being of a "technical" nature, they do talk to so many people that they often begin to notice patterns in the types of things that usually cause a person distress. " The trouble here is that all too often, when people notice "patterns", these patterns are based on their own experiences and their own interests, which are often limited. This often seemed to be my experience with therapy: Therapists would (probably not deliberately) fit what I said into the patterns/categories in their own head. They never gave explanations of why my situation fit into the pattern.

Another quote that is problematical for me: "For a fee, you can have the attention of an individual who will remember seemingly trivial things about your life, "interpret" what you say, and (at least to you) appear to take an active interest in your life." My experience with therapy was that the therapists often claimed I had said things I hadn't said (I don't think this was deliberate, but just that in their mind there were connections with what I said that obscured what I had said.) Also, therapist's "interpretations" typically seemed off the wall. This was really frustrating -- I remember one night not being able to sleep, and standing facing a wall, saying to myself, "I don't exist; I'm a figment of everyone's imagination."  I realize that that was an exaggeration, but it was an expression of the frustration of saying something, but having the therapist insist I said or meant something else than I said or meant.

Another  problematical quote:

15 hours ago, Evan2435 said:

appear to take an active interest in your life

Being treated as an object of interest was, for me, part of the problem. So therapists seemed to be more part of the problem than part of the solution.

[Mary S]

Sorry for botching the last comment -- I inadvertently hit "submit reply" while I was still trying to edit it.

[Eve B]

It's nice to know about the ideal world of therapy, but how many therapists really and consistently practice that way in the privacy of the session room? Clients carry most of the risk and burden when giving therapists the benefit of the doubt.

[disequilibrium1]

I definitely think the first step is the therapist not only to acknowledge his limitations, but continue to reinforce that message both directly and through minimizing hierarchical language. I believe a therapist can be a sounding board, at most.
As a client, I can be more than aware of patterns I repeat, yet still helpless to interrupt them. Part is my fears and reactions that remain and part is how the world responds to me.