Psychotherapy Isn’t Always About Becoming Better

Psychotherapy is the process of acclimating one to the ordinary.

Many, however, approach treatment in the opposite way, looking to psychology for answers on how to become special or, even worse, unlock their inner kings or queens. People often consider psychotherapy as a validation of and springboard for their narcissistic drives. They may have good jobs but want a more exciting career. They may have loving partners but want passion. And they may have good friends but want clout. (These things aren’t good or bad in themselves, depending on how much mental space they take up and distress they cause.) To them, unless you’re progressing, you’re decaying. Therefore, stagnation always feels intolerable, even if nothing is wrong externally.

A patient may enter treatment with a litany of complaints, noting how they could have been a great this or that. Implied is blame, criticisms of all of those who held them back. So, rather than considering how and why their relationships suffer or how they contribute to their perpetual unhappiness, they instead focus on external rewards, which of course they feel entitled to. And one of those rewards may be the acquisition of the therapist’s admiration. Our perfectionistic patients, much like in their normal lives, may use treatment to stand out, to become special. These individuals tend to be diligent, insightful, punctual, and resilient. Treatment, in their assessments, is, in large part, organized around becoming the best patient on their therapist’s roster. And, in reality they often are.

So, what does it mean to be a special patient? Exactly what it means to be a special person, in whichever manner it’s defined. The perks, unfortunately, aren’t very special. In this respect, the special patient still has to abide by all of the boundaries of treatment. And there’s no great, external prize for their efforts. Yes, the therapist may admire them, but that’’s as far as it goes. Some patients often dream of life-changing treatment, especially the ones preoccupied with “root causes,” believing in the existence of some yet-to-be-unlocked life level. Whether it’s emotional mastery, high-status, or cultivating extreme likability, they may harbor the not-so-secret belief that their lives have limitless potential. So, as you can imagine, their therapist’s admiration, like any other achievement, may inevitably feel like a letdown.

I often ask my patients: “What did you believe was going to happen?” People may remark with comments like: “I thought I would finally love myself.” “I wanted to feel worthy.” “I was tired of suffering.” We tend to put so much pressure on ourselves to rise above our lives, as though they’re only worthy of contempt. “Not good enough” may be the perfectionist’s mantra, yet, somehow, it seems to be ubiquitous, leaving others wondering if good enough exists. Perfectionists utilize admiration to signal being on the “right” path, which is, in large part, why they always crave it — deviation from it signals regression. Yet, admiration is often only just that — with no deeper meaning behind it, contributing little to nothing to some larger life story.

Psychoanalyst Wilfred Bion famously wrote about good therapy being a project that “increases the patient’s capacity for suffering,” but I would add: for many of our patients, the notion of suffering casts a wide net. Therefore, we try to help our patients embrace their less than glamorous lives, de-emphasizing what feels personal. This entails accepting boredom, chronic interpersonal disappointment, fading looks, impressive skills that won’t necessarily make them rich or famous, admiration as distinct from love, love as distinct from emotional security, emotional security as distinct from happiness, happiness as distinct from satisfaction, and satisfaction as distinct from suffering. The perfectionist’s life is organized around getting all of their needs met at once, yet life, being mundane as it is, precludes us from experiencing a sense of reality-based euphoria, meaning that our experience of it is always based on delusion.

Perfectionists have to learn to live with feeling incomplete, a state from which they feverishly attempt to escape. Completeness is an illusion, a concept which may form the foundation of one’s sense of meaning. But, it’s like playing whack-a-mole, as more problems and reasons for discontentment continue to spring up, so, ultimately, there’s nothing to fix.

The existential philosopher Soren Kierkegaard famously wrote, “Life is not a problem to be solved but a reality to be experienced.” Implied is the reality of incompleteness and the requirement to find a way to live with it. Each time I write, I always feel like something is missing. And when I figure out what that is, I have to write anew. But after I begin anew, I again end up feeling like something is missing. The same goes for any achievement. Life is not to be completed but embraced; it’s up to us, however, to shift our focus.