This week, a story in Newsvalley, asked the question “Is talking disappearing from depression therapy?”
The question followed the death of beloved actor, Robin Williams, who was reported to have been seeing a therapist for his depression in the period preceding his eventual suicide.
Robin Williams himself starred as a therapist in the award-winning movie Good Will Hunting, where his character touched the heart and mind of a troubled young man through the kind of talk therapy the article is wondering if might be disappearing.
Talk in talk therapy is of course a lot more than talk. It is about facilitating the kind of speech that evokes forgotten or suppressed feelings, and may never have been spoken before. It is creative or novel speech, not simply the rehashing of old events or the telling of stories. In and through speech people discover what they really think, just as is suggested by the expression: “to know what I think, I must first see what I say”. Speech, when it is therapeutic, or spoken from the right place, is a lot more powerful than we give it credit for…
We Are a Culture of "Doers":
Unfortunately we live in a culture that does not value speech. The expression, “she’s all talk and no action” communicates that what matters in life is to act, and that thinking and talking are simply pre-stages to actions.
When Democrat John Kerry ran for president a while back, I remember with amusement, how Fox News spun his trip to France as an indicator that he was an “intellectual” not a “doer”. In America we don’t sit around thinking lofty thoughts like the “French”, the newscasters suggested, we “get things done!” Ludicrous as this spin was, it likely struck an emotional cord with most Americans, who have been brought up in a highly competitive capitalist society and have been taught to value productivity and accomplishment above all.
This kind of action-orientation has also found its way into the field of mental health. The popular understanding of problems of living is that they can be mastered just like another work-assignment. Barnes and Noble is full of self-help books that promise amazing results through easy steps and suggestions for whipping oneself back into shape. They espouse the idea that thoughts can be “engineered” and that you can choose to act differently through various mind-tricks.
The Engineering of Depression Therapy:
This mentality has of course also found its way into the ranks of therapists who are quick to embrace this popular view of psychology as a toolbox of tips and tricks to master one’s issues. Undoubtedly driven by a popular demand for this kind of solution- and action-oriented approach to problems, therapists have been eager to adopt a new line of “technical” treatments for mental health problems.
CBT or Cognitive Behavior Therapy is quickly replacing the kind of relationship-based “talk therapy” that helped the character Will Hunting confront his depression. Therapists eager to meet the popular demand for quick solutions, and training programs eager to turn therapy into a technology, have rushed to embrace this newer more modern alternative to traditional talk therapy. Research studies are often touted as showing the superior benefits of CBT, and psychiatrists now prescribe it, like they prescribe a pill.
The Problem with CBT for Depression:
Unfortunately, the kind of therapy that benefitted Will Hunting, would not have been accomplished through CBT. A person does not experience a transformation in how they feel about themselves by filling out worksheets, or approaching their problems by becoming more rational about them.
The cure of Will Hunting was an emotional cure. Robin Williams was attuned to Will Hunting and was able to work with him so that Will was able to speak new words, and speak them from a new place within.
This new place within has to be accessed and discovered in and through a gradual and unfolding process, where a person first has to become vulnerable. Will had to trust his therapist, not by some rational command to do so, but by having a new experience of relating to another human being.
In the process of deepening his trust, Will had to be made aware of all the barriers to letting his guards down, including his fears of his emotional pain, his anger at others, and a host of other feeling and reactions that this kind of therapy process evoked in him.
And of course, along the way, Will had to speak of these new or sometimes “old” (but forgotten) experiences so as to make them part of himself and part of his own spoken reality.
Our Reality is Made of Words:
As cultural beings, we live in our words. Our human reality is a spoken reality: a reality of meanings brought forth by words and ideas.
Existentialist philosopher, Martin Heidegger, talked about language as “the house of being”. By this, he meant that language gives our ambiguous reality a kind of permanency that we are able to live within. This kind of permanency can consist of a “common sense” understanding of the world, that we are not even aware of, but that we take for granted when we approach ourselves as a technical machine in need of a quick fix, or think of our problems as “issues” that should be managed, mastered, and controlled.
Will, however, needed to let go of control, not increase it, and he needed to speak from a place that was different from the place he inhabits in his day-to-day life. He did not need his issues to be turned into problems to be mastered like another work-assignment. He needed space and patience, so he could begin to hear the voices of his subdued and suppressed feelings. He needed therapy to be an experience, not a set of procedures or dictates convincing him to be more rational or act opposite to his feelings. He needed to stop "doing", and start "listening". He needed to let go of his need for mastery, so he could begin to receive a different wisdom from within.
The Best Therapy for Depression:
The kind of talk therapy provided to Will Hunting is in my opinion the superior therapy for depression.
Depression may temporarily be mastered through consciously challenging and rectifying irrational thoughts, but it cannot be cured until the emotions fuelling the irrational beliefs are experienced and reworked in and through the therapy.
What motivates us to act is not simply will-power and logical understanding. We are driven to act and to repeat patterns in our relationships by our feelings, not our thoughts.
CBT rests on the assumption that feelings are simply the bi-products of ways of thinking and that a conscious choice to think differently will also make us feel differently.
I believe this way of thinking is overly simplistic. Most times people can quite readily see that their depressive thoughts are quite irrational, but that does not change a thing. Simply telling somebody or telling oneself that one’s thoughts or feelings are not rational, or replacing them with a more rational alternative, does not have the power of conviction needed to truly transform how we feel about ourselves. The goal of therapy should therefore not be to increase mastery of our feelings through our reasoning. Instead it should be to bypass our reasoning altogether, so we can effect change directly at the emotional level.
Why Talking May Be Disappearing from Depression Therapy:
The problem with the kind of therapy “Will Hunting” received for his depression is that it is hard to sell to someone who has not yet experienced it. It is a bit like describing how great a hamburger tastes, or telling somebody how thrilling a roller-coaster ride will be, to somebody who has never tasted a hamburger or been on a roller-coaster ride. To truly understand it, you must experience it, and until you have, it won't make much sense.
In addition, because people don't understand talk therapy until they experience it, they don't know to ask for it, nor do they even know they want it. This makes it a much harder sell than CBT, which readily fits with our common sense understanding that our problems are best solved by will power or by technique.
And yet at the end of the day, Will Hunting was transformed, not by doing, but by slowing down and getting in touch with something stirring within. His was a talking cure , not a technological intervention.
About me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas. I am a therapist providing psychodynamic therapy for depression.