John's Blog

The Blog of John Gibson, PhD

Therapy is More than Advice-giving

Suppose you’re struggling with a problem and you ask someone you trust for advice on how to solve it. Most people are only too happy to give it to you. Maybe they have personal experience with the concern in question, or maybe they know somebody who had a similar problem. Either way, this very well might you help you. Especially if it’s a practical problem and not too complex.

Or maybe you consult the all-knowing internet, a magazine, or a book. In our world, advice is not hard to come by. It’s everywhere. And if that’s true, why would you bother going to a therapist with an emotional concern? Why not just use one of the other readily available resources?

Many people have, in fact, made this very argument to me.

In social settings, sometimes people will ask, “So, um, what do you tell people who have problem x?” As if giving advice is what therapy is about.

Except it isn’t.

Advice is generalized information that can be tailored to the many, but therapy is tailored to you. Your problem may be similar to the problems that others have–-indeed, many emotional concerns are universal––but your circumstances, goals, and needs are likely to be different. Moreover, your problems do not occur in a vacuum. Your personal history is unique to you and it serves as a broad context in which to understand your problem.

As a therapist, I listen carefully to my clients. I take pains to get to know who they really are, something a columnist in magazine will not do. I try to understand my their unique psychologies. And I lock in on the various psychological factors–-thoughts, feelings, conflicts, beliefs–-that keep them stuck.

Do I give advice? Sure. Sometimes.

But not all clients need advice. Some clients need to listened to and understood at very deep level (think: unconscious mind). Some clients need to be encouraged, coaxed, or persuaded to try something new, even though it feels risky, hopeless, or fearful. Some clients need to have someone believe in them, support them, or root for them as they try–-yet again–-to make a change. Some clients need to be confronted with self-discrepancies or self-destructive behaviors (gently). Some clients need insight into patterns of behavior, relating, or resistance. Some clients need to clarify their feelings, often hidden, or simply experience them in the presence of a caring human being. Some clients need to be challenged. Some clients need acceptance.

Some clients need all these things, and more.

If years of doing therapy have taught me anything, it’s that most human problems--depression, anxiety, relationship issues, career troubles, et cetera--are more complex than they appear on the surface.

Which is why common advice so often fails.

The Four Sentences that Lead to Wisdom

I'm sorry.
I was wrong.
I need help.
I don't know.

Bury Your Dead, by Louise Penny).

Ah, the good life. But what is it?

I like Martin Seligman’s definition. The good life, as he sees it, is made up of five components:

  • Positive emotion. Otherwise known as feeling good.
  • Engagement. Activities that cause to lose track of time, for instance.
  • Relationships. We are hard-wired to connect. Good relationships make for a good life.
  • Meaning. Making an investment in something that is bigger than one’s self.
  • Achievement. Accomplishing things that matter to us.

Happiness is more than feeling good. Ever tried to learn a musical instrument? Complete college? Play Bridge? Play a sport? Some activities test us and tax us, but they may come to have deep meaning for us nonetheless. Seligman suggests that “feeling good” may be the least important component of the group.

Which doesn’t mean we don’t want to feel good. We do. It’s just that there may be more to happiness than positive emotion.

Also, it’s not enough to achieve our goals; we also need to
appreciate our achievements, perhaps even savor them.

What the good life is not: the wealthy life, the ideal life, the stress-free life, the idle life.

Is the Anticipation of a Panic Attack Worse Than the Panic Itself?

Maybe. At the very least, for many sufferers it’s almost as bad.

When it comes to positive events, anticipation can be a good thing. If we’re anticipating an exciting vacation, say, or a cherished holiday or other event, the tension of the waiting itself can enhance our enjoyment (especially if we are adept at

But what if it's a negative event? Panic attacks cause people to feel deeply afraid. The sufferer experiences the emotion of intense fear, not to mention disconcerting symptoms like shortness of breath, rapid heartbeat, or tingling in the extremities (and more). Fortunately, panic attacks are typically short-lived phenomenon. They pass. The sufferer’s physiology goes back to baseline.

Well, not quite. Because in the back of the sufferer's mind there is this terrible, worrying question:
When will the next one occur?

The panic sufferer often becomes hyper-vigilant to the prospect of another attack. The first attack was so aversive that it’s as if the sufferer must constantly be on guard for the possibility of another, lest he or she be caught unaware. A portion of the sufferer’s attention is devoted to keeping a close eye on the body’s sensations, scanning and searching for any sensation, pain, or symptom that might foretell a panic attack.

Unfortunately, the more the sufferer cues into sensations of the body the more keyed up he or she becomes, thereby increasing the chances of another attack. This hyper-vigilance simply revs up the nervous system and once the body is on high alert it doesn’t take much to trigger an attack. And if (when) one finally does occur, it's as if the sufferer tries to become even more vigilant that before. As you might imagine, this creates a vicious cycle. Conversely, sometimes the panic attacks themselves subside, either through treatment or the natural course of things, but the anticipatory anxiety remains. For many sufferers, living with anticipatory anxiety is almost as bad as tolerating the attacks themselves.

I think of panic disorder as having three overlapping components. The panic attack itself, the anticipatory anxiety, and the
avoidance of situations that might trigger an attack. Sometimes in treatment we need to break the disorder down and work on each component separately.

And yes, panic attacks can definitely be treated. It takes persistence, patience, and a willingness to examine your mindset (thoughts, beliefs, feelings, fears). Even with complicating factors (e.g., over-reliance on alcohol, a well-establish pattern of behavioral avoidance, health issues, or over-reliance of anti-anxiety medications) real gains can almost always be made.

Fear doesn't have to win.

What Therapy Really Is

A therapist cannot change you. He can listen to your deepest concerns; clarify your wishes and wants; help you understand your emotions; challenge your thinking; be objective about your situation; invite exploration; support good efforts; coax you to try, just try; nudge you to stand up for yourself; confront your inconsistencies and irrationalities (gently); ask hard questions; appreciate your strengths; applaud your successes; provide information; teach new skills; worry about you; make direct suggestions; help you understand how dysfunctional beliefs are not serving you; and welcome your presence. But he cannot change you.

Only you can do that.

If you change, it’s because you took action. Maybe a small step here and there, a shift thinking or behavior, a risk, a new pattern. If you change it’s because you experimented with the idea of doing things differently. Maybe instead of fighting your truest, deepest nature, you made peace with it (and yourself). Maybe you treated yourself with love instead of criticism. Maybe you came to believe you were enough, just as you are.

If you change, it’s because you made it happen. You were willing to experience the discomfort that comes with resisting old habits and building news ones.

If you change, it’s because you made it happen, not your therapist.

We Need More Grownups

A grownup is careful not to make too many excuses when things go wrong. She takes responsibility for her actions. If she makes a mistake, or is late, or is unprepared, she doesn’t make excuses. It’s tempting to blame others (or the situation) for her lapses, but a grownup holds herself accountable.

A grownup does his fair share. While it’s tempting to let others do his work for him, a grownup readily pitches in whenever there’s work to do, and let’s face it, there’s always work to do. A grownup knows that if he doesn’t do his fair share the people around him–-spouses, partners, siblings, coworkers, friends––will eventually feel resentful. This, in turn, will sour or even poison a relationship.

A grownup does her best to make sound judgments. Like everybody else, she feels the press of impulses, the wish for instant gratification, the temptation to ignore long-term consequences. But a grownup tries to balance reason and emotion, want and need, impulse and thought.

There are plenty of people in this world who fit the age requirement of being an adult. But what really need is more grownups.