Therapy can be a good place to let someone know how bad you feel.
KEY POINTS
- In therapy, you will have a chance to express all of your feelings, no matter how strong they are.
- However, your therapist may not be able to “change your mind” about how life looks from your point of view.
- Instead, having a chance to be heard, and not contradicted, can sometimes make a difference.
Let’s call him “Henry.” He was young, rail-thin, and heavy-browed, and he came to therapy with a clear sense of what he wanted: cognitive-behavioral treatment. “I need someone to help me clear my head,” he would say. He said he’d been depressed for years, with no improvement despite changing therapists several times. When I asked about his last one, Henry said she’d only wanted to talk about his parents. “That stuff is all in the past,” he said. “I don’t need to talk about it.”
But talking about the future didn’t help much, either. Sessions with Henry often devolved into grueling discussions of the culture wars, the horrors of climate change, or the disruptions to our economy that he believed were likely to occur. News items like major events in Presidential politics, the development of artificial intelligence, or the war in the Middle East only gave Henry more grist for his downbeat mill. To Henry, the worst possible outcome was usually the most likely. His pessimism was as global as it was personal: to Henry, not only was the planet doomed, but his own life — paradoxically, equally important — would also be hopeless and unproductive. His industry, he said, was undergoing a radical and permanent contraction. Soon not only would he have no job, but there would be no industry left in which to have one — and eventually, no economy in which such a business could exist.
Sticking to the cognitive-behavioral script Henry had asked for, I worked to identify core themes in his presented material and used these themes to pick out the automatic thoughts that tormented him. I used the “downward arrow” technique to help him identify the worst-case scenarios he imagined. I employed careful logic to disconfirm some of his beliefs, engaging him in detailed discussions of — for example — some of the ways we as a species could work to moderate climate change. But no matter which facts I focused on, Henry would have others close at hand to contradict my points. And when I managed to challenge him successfully — when he had no response to a hopeful remark — he would simply change the subject to something that freed him to continue the downward slide of his mood. Even positive events in his life, such as occasional successes on dating apps, made no lasting impression: Henry simply construed them as flickers of brightness that would inevitably fade — which they generally did, both as a result of and as a furthering cause of his depression.
Nothing changed for months. Henry oscillated between mild, even bland descriptions of his daily life and fiery blooms of darkness and pessimism that felt increasingly angry, as though he’d begun to resent not only his inability to break free of these beliefs, but also my inability to take them away. It wasn’t easy to listen to Henry’s relentless negativity, or to absorb the implicit blame in the way he spoke to me.
When it arrived, the change came almost accidentally. In another doom-laden session, during which Henry came very close to blaming me directly for his unhappiness, he cast a similar aspersion on a member of his family. “My dad doesn’t listen either,” he said. This had a more plaintive and personal emotional tone than his usual material, so I asked for more detail. Henry said he wasn’t able to talk to his father — the family member to whom he had always been closest — about his sadness at all. “Stop dwelling on this,” Henry told me his father would say. “You don’t need therapy. Just pick yourself up.”
This made a difference, as it cast the many, unhappy sessions we’d had together in a new light. Whereas for weeks I’d been working hard to try to offer him a concrete new perspective, effectively I’d just been arguing with him rather than empathizing. Again and again, I’d failed to take the opportunity to see things his way. If his father — and his brother, and his closest high school friend — hadn’t been able to hear him out, perhaps I could do a bit better. Perhaps I could contradict his expectations in a new way: not by challenging his facts directly, but by showing him that not everyone would be pushed away if he expressed the way he really felt.
The next time we met, Henry began in the usual way. A disagreement at work seemed to threaten the stability of his job, which meant — in his mind — that a sacking, and unemployment, and the end of his career — would not be far behind. But instead of turning a skeptical eye, or reminding him that he’d gone through similar problems in the past without serious consequences, I just said I was sorry he’d gone through that experience. He paused at this, as if waiting for me to shift back into a familiar gear. Instead, I waited. Henry went on about his problems at work, though with more hesitation this time, and I did my best to take in what it meant to him, and how it felt in the moment. When he’d finished talking, I told him again that I was sorry — this time, sorry I couldn’t take away his problems.
“That really sucks,” I said.
He countered with, “That’s really all you have to say?”
I shrugged. I told him what it sounded like to hear him talk about the things that bothered him — that he was in pain, that he seemed to feel constantly surrounded by problems, and that he had trouble finding joy or even peace of mind. “It sounds awful,” I said. “I know I can’t stop you from feeling that way, but I do want to go on hearing about it.”
Of all the things I had said to him, this seemed to hit him the deepest — which became clear to me when I realized that in response, he just didn’t know what to say. He hadn’t had this experience before; he had no reference point for being told he had value, despite his unhappiness, and that his point of view was real and legitimate. He’d never been able to go on about his depression without someone important — such as his father, or his closest friend — trying to talk him out of it. Perhaps he had come to expect this, and had even anticipated it by asking for cognitive-behavioral treatment. So without fully meaning to, I’d stumbled into a new way of hearing him, and showed him a new way to look at himself.
Since then, therapy has been different. Not different in content — he still has a lot to say about the coming economic apocalypse and climate crisis — but different in tone. I no longer try to challenge his views, and I don’t have to show up ready for a debate. When he talks about problems at the workplace, for instance, he stops after a few minutes and checks in with me. “This isn’t boring you?” he’ll say. He seems to be asking, “Am I still OK, even though I feel bad about so many things?” Without having to say so, I mean to let him know that he’s a good person, with an outlook worth understanding, even when he feels bad. But I just say no, he’s not boring me — and I’m always happy to hear more.
NOTE: Names and details about this case have been changed, in some cases significantly, to protect the confidentiality of the person or persons involved. However, the course of treatment described here is accurate.