Do We Need Therapy? Psychology and the Problem of Human Suffering: What Works and What Doesn't?

Jack Cummins

People have always experienced suffering in some form or another and there are no easy solutions. Some writers have spoken of distress as the 'dark night of the soul.' Life in our times involves many stresses, which include general and specific ones. A lot of people are being prescribed medications for their distress, but for lesser forms of difficulties, or even in conjunction with medication, people often choose therapy, but we can ask to what extent is it always helpful?

I am not a fully fledged therapist but have done some training in various therapy approaches and also, have some experience of being in therapy, as a mandatory requirement of training in certain forms of therapy. One big debate is the whole contrast between the psychodynamic approach to therapy is the cognitive behavioral therapy approach.

The psychodynamic approach stems from the approach of Sigmund Freud and draws upon the idea of the transference, which involves the relationship between the therapist and the client, especially what is projected onto the therapist. The whole tradition has also been developed by Melanie Klein, Donald Winnicott and others. It can take the form of individual or group therapy. It can be done sitting down or with the client lying down on the couch. It involves asking the person to think about the past, including childhood experiences.

The cognitive behavioral therapy was developed by Beck and Ellis and focuses upon the here and now, in contrast to the past. It involves looking at negative assumptions underlying beliefs. It can be used for a variety of issues including anxiety, depression and obsessive compulsive behaviour.The client is asked to do homework in between sessions. One idea which I have come across within this form of therapy is that of enabling the person to become their own therapist.

There are many other forms of therapy available, including person-centred counselling and therapy based on mindfulness. Some are more widely available. Also, there is more evidence based research to back up cognitive behavioral interventions than psychodynamic approaches. However, some forms of therapy outcomes are hard to measure in a definitive way.

I am asking about how therapy helps in response to the problem of human suffering and asking to what extent it may help? Can it even aid in the experience of nihilism?

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javi2541997

↪Jack Cummins

Does therapy help to the people when they are suffering from depression, negative thoughts, etc...? Of course yes. But in the terms of how it could be improve the therapy itself is quite difficult. I do not have as much as experience as you in this field. But I guess it depends a lot of individual's motivation to change. I can't go to a therapist pretending they are like "wizards" and then they will change my life forever to be happy. This is the main reason why the psyque is so complex I think. Sometimes I don't even know why I feel stress or with lack of motivation so I can't imagine how I have to explain it what happens to my mind to a therapist.

Nevertheless, I think therapy is essential for mental health because it prevents you from taking drugs. I mean all kind of drugs (permitted by pharmaceutical companies like "Prozac" or forbidden by States like weed or heroine). This is exactly what I am wanting to go. Sometimes we all have problems related to mental issues or order that we don't know where to scape for. In this complex context I will always recommend go to a therapist just to being listened by instead of consuming pills and get "quick happiness"

But again I am not so experienced in the world of human suffering and I do not know why sometimes psychiatric recommends taking "prozac" to be "less" depressed.

Jack Cummins

↪javi2541997

Personally, I think that what works is very individual. I remember one art psychotherapy saying that the most important aspect of therapy is having the right therapist. Perhaps, part of this is finding someone to relate too, but I would also think that it has a lot to do with the attitude and knowledge of the therapist. I do believe that becoming a therapist is not a task or profession that should be entered into too lightly as it calls for such depth of understanding.

As far as medication goes, I am not against it if it is necessary. That is because emotional suffering does have such a profound influence upon biochemistry, especially Serotonin and other neurotransmitters. When people get to the point of being psychotic, I do believe, based on my experience of working in mental health care, that it would be detrimental to work with therapy until some antipsychotic medication was offered to address the psychosis at the biochemical level initially.

javi2541997

I remember one art psychotherapy saying that the most important aspect of therapy is having the right therapist. Perhaps, part of this is finding someone to relate too, but I would also think that it has a lot to — Jack Cummins

Having the right therapist is a gift. Also I am not here to criticise all the therapists because I would sound so ignorant. Being a professional in something so complex as human psyche could be sometime so difficult to find the “right” solution for each person. Nevertheless, I am agree with you said about knowledge. Yes I guess there actually exists some basic “parameters” which could help each individual and try to find a solution.

That is because emotional suffering does have such a profound influence upon biochemistry — Jack Cummins

This one is so interesting and thank you for clarifying this concept. I guess I spoke in so general terms previously. True, sometimes it is very important the medication but clearly when someone really needs it (as you explain, people that could suffer of psychotic). But those are special cases.
In the other hand, I still maintain the danger of taking so much pills if you can avoid it. I mean, I wish taking this medication would be the las thing to do if it’s necessary.

Jack Cummins

↪javi2541997

I would just wish to add, by commenting upon your remark about drugs and alcohol. I am not someone who is opposed to some kind of drug experimentation. Most of us are curious to find ways of relaxation. One of the biggest problems connected to using weed is the way in which it is recognised now by many as being a trigger of psychosis. There is the whole field of dual diagnosis of psychosis and substance misuse.

As far as alcohol is concerned, I would say that many people find it helpful in relaxation and for social interaction. However, I have read that there is a rising problem of alcohol misuse in the pandemic and we may not know the full extent at present. Pubs are shut down but when I am in supermarkets I see people piling it into their trolleys. The people drinking alone, with no one to talk to me may be a whole group needing therapy at some point in the future.

Jack Cummins

↪javi2541997

I think that I was adding my comment while you were replying. The one thing I would say in response to your last post, is the whole issue of side effects of psychiatric medication. The newer antidepressants are better, but so many medications have effects of weight gain and potential for triggering diabetes.

Nevertheless, untreated mental illness can have a terrible impact, including suicide risk. It would just be so much better if people's difficulties could be addressed at a stage earlier, with a view to people talking about stresses, which when unprocessed, can so easily translate into serious mental illness.

javi2541997

Nevertheless, untreated mental illness can have a terrible impact, including suicide risk. It would just be so much better if people's difficulties could be addressed at a stage earlier, with a view to people talking about stresses. — Jack Cummins

Probably sometimes mental illness is untreated because it is still a taboo issue in some societies that do not respect the big problem actually means. Since the day we make as ordinary go to the therapist probably the context would change and then we could prevent many risk of mental illnesses as suicide.
I wish one day we start having more exercise of empathy with others and not making bad jokes because they are sad or living a bad moment.
I remember when I was university I was depressed. Nobody understood me and even made fun of me so I felt so lost that I was in the risk to take drugs (LSD). Hopefully I met the right therapist and I didn’t do so and I starting seeing the life with a different point of view. This is why I always recommend go to a therapist when the context starts going wrong.

The people drinking alone, with no one to talk to me may be a whole group needing therapy at some point in the future. — Jack Cummins

Of course this situation will lead many people go to a therapist in the future. Covid-19 and its pandemic taught us how difficult is live in loneliness. All of those who were frequently visiting pubs didn’t know how to pass the shut down properly so they decided drink alone.
I don’t know how much affect drinking alone but I guess it could be so interesting to see in the future how this people interact in society when everything would be again in “normality”. Will they still drinking in house alone or in the pub socially? This point that you commented is so interesting.

Jack Cummins

↪javi2541997

You are right to say that there is an incredible amount of stigma surrounding mental illness. I do believe that this prevents many for seeking support.

Also, alcohol represents such a whole area for questioning. So much of social life is embedded in a culture of alcohol. People grow up and are socialised to begin to go to the pub, almost as soon as they outgrow the pub. Alcohol is the legal narcotic. I also tried weed and acid, but the whole process of getting these was a horrible drama in itself, going to strangers and being sold substances which were fake.

But I do believe that so many people are struggling at present, with mental health issues. One of the latest trends is therapy online but I am not convinced that this will be enough for many who are struggling. Also, mental health cannot be separated from real problems in the physical world, including poverty and homelessness. Obviously, the real practical problems need to be addressed but I think some therapy is needed, because people need to be able to talk about their experiences.

unenlightened

If I were to ask, "Do we need clothes? What works and what doesn't?" I might get all sorts of answers. Inuit tend to opt for seal-skin, Hawaiians for grass skirts. Neither is quite appropriate for the London underground.

I am asking about how therapy helps in response to the problem of human suffering and asking to what extent it may help? Can it even aid in the experience of nihilism? — Jack Cummins

It can be a life saver, and it can be quite useless and even damaging. More power to to your non-directiveness or whatever you bring to the couch.

But every therapist should ask themselves very seriously and regularly whether they are helping people to tolerate the intolerable, rather than regain full agency in their lives. It should be the last rather than the first resort to an explanation of suffering that the cause is in the mind. Many people live in oppressive, stressful maddening situations, and they need practical help before anything else.

Likewise, the therapeutic effect of an appropriate environment and community should be part of any treatment program. My own favourite therapist is a tree, specialising in end of life and bereavement counselling.

Jack Cummins

↪unenlightened

You are right to say that therapy 'can be a lifesaver, and it can be useless or damaging.' I think that is probably the whole basis for my raising the topic for philosophy debate in the first place.

Actually, when I did undertake psychoanalytic therapy, at times it made me feel much worse about my life. I heard some therapy tutors say that sometimes things have to get worse before they get better. However, I did wonder how far this has to go.

Also, the whole need for therapy is based within cultural contexts. Perhaps, people have no one to turn to in the community and that is why they end up seeking therapy.

Tom Storm

I am asking about how therapy helps in response to the problem of human suffering and asking to what extent it may help? Can it even aid in the experience of nihilism? — Jack Cummins

Therapy is no different to any other human activity. You can get good and bad practitioners and models. Generally people need to shop around to find a therapy mode or a therapist they find beneficial. The relationship with the therapist or therapeutic alliance is more important than the mode of therapy. This has been found in most of the research. Practical solutions focused interventions appear to be most beneficial. Merely talking is not likely to be enough.

I am not fond of the term - 'an experience of nihilism'. This is a red herring. If a person is experiencing anhedonia and truly believes that nothing matters this is rarely an expression of philosophy, Camus style. It is usually chronic depression and warrants treatment.

javi2541997

People grow up and are socialised to begin to go to the pub, almost as soon as they outgrow the pub. Alcohol is the legal narcotic. — Jack Cummins

Interesting fact about this: I am from Spain and alcohol is legal due to a lot of taxes it produces to the State. It also happens to the tobacco. So I guess my governors think it is worthy having theses substances because despite they are drugs are kind “soft”. Nevertheless my country is not the only one who manages alcohol and tobacco as taxes I guess...

One of the latest trends is therapy online but I am not convinced that this will be enough for many who are struggling. Also, mental health cannot be separated from real problems in the physical world, including poverty and homelessness. — Jack Cummins

Agree with this point. It will not enough online therapy. Also as you said it depends a lot the social context of the patient: additions, poverty, bankruptcy, etc...
But as you explained I do not get about getting related to “community”. Do you mean socialising and having friends, etc...?

unenlightened

Actually, when I did undertake psychoanalytic therapy, at times it made me feel much worse about my life. I heard some therapy tutors say that sometimes things have to get worse before they get better. However, I did wonder how far this has to go. — Jack Cummins

It slightly bothered my that you put the emphasis on suffering, and reducing suffering. The phrase "comfortably numb" comes to mind. Will you choose a deep love and a painful loss, or a shallow life of little suffering?

I want to be more sensitive, not less, and that means more suffering too. Think of autonomy, of resilience, of agency, of relationship; less suffering is a too small a goal, too weak a measure of success.

Jack Cummins

↪unenlightened

I think that the question you raise is really interesting. Do we wish to be made less sensitive or more. In a way, medication and even pleasure can have the effect of numbing us. Personally, I have been described as lacking emotion at times, and too emotional at others. Both seem bad, and I am not sure which is worse. Of course, it is also about how we express emotions. When I was on an art therapy course, there seemed to be a lot of emotion and that felt false. However, the point where we switch off emotions is also worrying, and how do we navigate the way to the right balance for our own mental health and that of others?

BC

↪Jack Cummins

↪javi2541997

There was once (1970s) a small magazine, The Radical Therapist", whose motto was "Therapy means change, not adjustment." Their logo was a chick just-hatched from its egg shell.

I've taken medication and used talk therapy for depression and anxiety; I've benefitted some from both. What really worked was substantial change in life circumstances. I wasn't successful in engineering the changes that worked -- that came about by chance events.

I spent decades being a discontented person, and regularly sharpened the edges of discontent. [Fan the flames of discontent--old labor slogan] My expectations of what life was supposed to be like were not all that well grounded in reality, a good share of the time. As I got older, I found work life increasingly oppressive and stultifying.

A lot of my personal history became clear after I retired and began reflecting on my life. Theoretically with 20/20 hindsight, I could have thought about life differently and been happier.

Today I feel mentally contented, effective, and happy; I do happen to be hooked on an anti-depressant. I don't know whether it does any good--just that I experience very unpleasant withdrawal when I try to stop. I'll probably take it until the end.

Jack Cummins

↪Tom Storm

I definitely believe that finding the right therapist is important for most people and that can be a long and arduous task. I have known some people going from therapist to therapist, desperate to find the right person. However, I do wonder how much is about our own individual approach and how much we project onto the expectations of the therapist. I do believe that it is partly relates to where we are and what exactly we are looking for in therapy.

You are the first to speak of the way in which I have mentioned nihilism in my introduction. I am not sure if it is a red herring or not, because I do think that the experiences of nihilism is a position of despair, but it is not simply the experience of depression, or is it? I once knew someone who sought enlightenment and could not find it. He struggled, with extremes of feeling high and low. He spent so much time in bed and felt flat and without any meaning. This seems to me to be the ultimate expression of nihilism. When someone gets to that point it is questionable to me how one can rekindle meaning. If the person was to enter into therapy it is unclear to me whether that would happen or not, because it seems that some powerful insight ot source of inspiration needs to be conjured up for that person. The individual may be seeking this or have gone past looking, but the question is where can it be found?

Jack Cummins

↪Bitter Crank

I think that both medication and life circumstances are important. The question is where can people begin? Medication is meant to be a starting point from which a person can begin to be balanced enough to begin to make changes. However, we could question whether this always happens. Ideally, therapy is a means to explore ways in which that can happen. But I believe that you are right in querying therapy as meaning change rather adjusting. I would imagine that this is a complex spectrum. Perhaps, some would see being without medication of any kind as ideal but it may not be realistic.

So many people in the population are on medication of some kind or another, such as ones for basic physical health, and, surely, medication for depression and anxiety is just as valid. One of the biggest problems for many, including myself, is the being able to sleep and that seems to be a complex mix of physical and mental. I am not sure that it can be addressed fully by therapy alone.

Tom Storm

↪Jack Cummins

What you describe is depression and requires compassionate treatment.

Jack Cummins

↪javi2541997

I am really concerned about the way people are being offered online therapy. It does seem to suggest the idea of people alone in rooms tapping away on screens, and right now I am aware that I am doing just that. However, I feel that I have fun on the forum for I wonder if that would be the case in online therapy. I am not sure that therapy is meant to be fun, or whether philosophy is is meant to be either, but I cannot believe that it is meant to be all drudgery. There has to be some sense of satisfaction or fulfillment of some kind or another.

When I spoke of the context of the person in the community seeking some kind of support, or therapy, I am thinking of the way in which people's needs may only be met on a shallow level in many communities. I am not saying that everyone's needs are identical and basic human interaction may be the most important for many. However, it may be that family and community life create more conflicts than outlets for some. Often, going to a GP or mental health team may occur within those circumstances.

Jack Cummins

↪Tom Storm

I am familiar with depression because I have experienced it personally and I have worked with people experience it in in a mental health care. However, I am pointing to a blurry area for questioning: where do you differentiate between unhappiness and clinical depression? Anhedonia is a very real part of it, because lack of enjoyment colours our whole experience, but I think that it is a very complex topic. The question of nihilism is also about the experience of despair.

Tom Storm

↪Jack Cummins

Jack - analysis/paralysis. It is not very complex. If someone is in despair (whatever you wish to call it) and feeling chronic emptiness, it is likely to be depression and requires treatment/intervention. There is no sense in trying to analyze or categorize this one further. An inability to experience joy, with feelings of dread requires intervention.

unenlightened

There is no sense in trying to analyze or categorize this one further. An inability to experience joy, with feelings of dread requires intervention. — Tom Storm

Turns out, 80% of depressions can be cured by not having a war where you live.

https://www.technologynetworks.com/neuroscience/news/people-in-war-torn-countries-are-five-times-more-likely-to-develop-anxiety-of-depression-320553

antor

where do you differentiate between unhappiness and clinical depression? — Jack Cummins

The view which I have experienced, seems to draw the line depending on the individual. I mean I think you can easily compare to physical things like pain for example. Pain can be discomfort or it can cause actual concrete problems. Regardless, you don't sit around contemplating whether different treatments are actually necessary. You try them out and stick to those that work best for the individual. Ideally, that is. Yeah there may be cases where they have tried to hammer in a screw for too long but you can't really let extremes define your main strategy.

Jack Cummins

↪Tom Storm

From my experience of working within mental health care, the diagnosis of depression is sometimes complicated. If lack of enjoyment and despair come without other symptoms of clinical depression, such as feelings of low esteem, difficulties sleeping, changes in appetite and other activities of daily living the diagnosis of depression is questionable. In some cases, two different psychiatrists may assess someone and come to differing conclusions. Also, it all depends on what is treatable. Some people seem to respond better to treatment, especially antidepressants, than others. This is sometimes at odds with clear diagnosis categories, and seems to come down to biochemistry. But I am not saying that there is not more to it, such as the wish to feel differently.

Jack Cummins

↪antor

I do believe that we have to try out different options available, and if they are specific psychosocial options we don't have automatic access to them. We may have to be referred for options, including therapy, unless we are able to afford it privately, and the medical clinicians often act as the gatekeepers in deciding what may be offered.

Tom Storm

Turns out, 80% of depressions can be cured by not having a war where you live. — unenlightened

That's be my guess too.

Tom Storm

↪Jack Cummins

I have worked in the field for many years. All I am saying is people need not distract themselves with solving puzzles or wondering about criteria or this therapy versus that one, or how many types of classifications or schools there are possible. Bottom line: if you feel sad or unhappy in any way for an extend time. Seek help. Best response. There's no doubt that people distract themselves from treatment by many other activities or rationalizations. I would never say that therapy works for everyone or that medication is the answer, but astonishing transformations and improvements do happen all the time. Psychosocial options are critical too.

Jack Cummins

One idea I would also add for people to think that is one exercise a tutor on a therapy course I was doing. She asked us to imagine what miracle we could imagine what would change our lives. After that, she suggested that we pretend that this miracle had happened and how we would live following that. I found it a useful exercise and it was meant to be a way of thinking of dreams coming true. I found it really got me thinking about actually beginning to overcome obstacles.

Jack Cummins

↪Tom Storm

Do you work in mental health care? I have too, until last May. I am unsure if I plan to go back into this. However, I do experience depression at time, but and do seek help. I think that many are struggling currently but are probably suffering alone. You say about psychosocial interventions but I don't think there is much of that available for people currently.

javi2541997

You are the first to speak of the way in which I have mentioned nihilism in my introduction. I am not sure if it is a red herring or not, because I do think that the experiences of nihilism is a position of despair, but it is not simply the experience of depression, or is it?

@Jack Cummins

No. It is not simply being depressed but it is an important fact of experience nihilism. It all occurred back in 2017 when my best friend and I (we both love philosophy, ethics, psychology, etc...) decided the experience about nihilism. Nevertheless back then I was already experiencing it because I did not like the life I was living.
Talking about it during months we entered in a difficult situation where we reached not feeling sad but at the same time not having a goal/purpose in life... So I and my friend did not know what to feel about it. We were even close tl end our friendship because nihilism says nothing has a "reason" to believe by.
The months keep passing and we started becoming more "adults" in our 20/21 years old so we learned something about nihilism: This feeling happens sometimes when you are depressed but also when you have stimulus around that give you the opportunity of thinking in other thing instead of being like a vegetable "standing" there with zero reason. I accepted myself (as my friend did) and then my life went better.

In this point, I do not know if nihilism will back again in my life. I hope not. It will depend in my behaviour and stimulus around me.

Isaac

There is no sense in trying to analyze or categorize this one further. An inability to experience joy, with feelings of dread requires intervention. — Tom Storm

Turns out, 80% of depressions can be cured by not having a war where you live.

https://www.technologynetworks.com/neuroscience/news/people-in-war-torn-countries-are-five-times-more-likely-to-develop-anxiety-of-depression-320553 — unenlightened

That's not the conclusion of the study cited. Even a cursory read shows that. The very first sentence is "People living in countries that have experienced armed conflict are five times more likely to develop anxiety or depression", which means that 80% of depression/anxiety could have been prevented by not having a war. The study says nothing about curing it.

PTSD is without doubt caused by trauma. Does not having that trauma anymore cure it?

Do We Need Therapy? Psychology and the Problem of Human Suffering: What Works and What Doesn't?

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