Why Don’t You Take This to a Friend?

Psychotherapists Jacqueline Olds and Richard Schwartz, writing in Harvard Review of Psychiatry, argue in a way for aspects of making our profession obsolete.

There has been a demonstrable decline in the average number of confidants that most people have.  Psychotherapy has contributed to the fraying of the social fabric by implying that confidences are best saved for the ears of therapists rather than shared with close friends.  Many Americans are lonely “frequently” or “almost all the time”, as one recent study suggests, and many have heard from friends something along the lines of “This is too much for me to handle; maybe you should see a therapist.”

Overall, community has deteriorated drastically in our culture for complex reasons, including a deep distaste for depending on others and an overvaluing of independence.  This discourages reliance on friends.  Turning increasingly toward the mental health system medicalizes their problems and implies the promise of a quick solution through medication.  This emphasis on self-sufficiency imputes an almost magical knowledge and ability to therapists and hollows out the meaning of many friendships.

The skill of close friendship is disappearing and therapists must realize and remind their patients that therapy is not the perfect blueprint for everything friendship should be. It is a one-way relationship which excludes the joy of reciprocal empathy and understanding found in a true friendship. People are forgetting how to do their part to sustain friendships and therapists inadvertently make the problem worse through their skill at sustaining a relationship with very little help from the other person, creating a very unfortunate and inaccurate model of a good relationship.

Rekindling the joy of having someone one can talk to from their heart must not be forgotten as a core focus of therapy.  Therapists need to remind themselves and their patients that an important goal of therapy is, in a sense, to make itself obsolete, to make it possible for the patient to experience the same satisfaction, the same experience of being thoroughly known by another, outside of the therapy relationship.

It is important to take note of psychologist Sidney Jourard‘s 1964 observation in The Transparent Self of the necessity to have at least one person in your life with whom you “could truly be yourself”.  Relying on therapy alone will devitalize all the other relationships in the patient’s life, depriving them of degrees of connection and closeness. Enhancement of the patient’s interpersonal connectedness and quality of social supports should remain a core focus of psychotherapy.  Measures that assesses social consequences of psychological treatment should be a standard part of psychotherapy outcome studies.  Further attention should be paid to which specific psychotherapeutic approaches have the most salient effects on social connection.  The discipline called interpersonal psychotherapy (IPT) stands out for an exclusive focus the interpersonal context and treatment strategies for improving close relationships.

Improvement of social adjustment is taken into account to different extents in different treatments for different health problems.  For certain conditions (depression and other mood disorders, obsessive-compulsive disorder, etc.) all treatments including biological ones improve social adjustment.  In other conditions like schizophrenia, deliberately targeting improvement in social connections is required.  The importance of social network’s for maintaining sobriety shapes service delivery in alcohol and substance use disorders.

In the meanwhile, while awaiting the empirical research, some simple measures in all therapy relationships are likely to contribute to an improvement in patients’ engagement with others outside of the therapy.  Therapists have to pay attention to the quality of patients’ other relationships even if that is not the primary focus of their treatment. They should be explicit with their patients about the danger of refraining from important conversations in relationships with others.  They should point out that much of the relief, comfort, and perspective offered in the professional relationship can often, as easily and effectively from a friend.  With certain questions and worries, therapists should probably actually suggest, “Why don’t you take this to a friend?”



5 Differences Between Talking to a Friend vs a Therapist (avalonmalibu)

Your Friendship Will Always Be The Best Kind Of Therapy (thoughtcatalog)

How Is Talk Therapy Different From Talking to a Friend? (verywellmind)

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