“Therapists are magicians. I take that back: GOOD therapists are magicians,” In her book What Made Maddy Run, ESPN reporter Kate Fagan quotes this young writer who, on the brink of ending her life, finds life-saving help through counseling.
Of course, we all know there is nothing magical about therapy. However, there is something specific about the process, the content, and the interaction that makes it uniquely positioned to change someone’s life.
I am privileged to be both a clinical psychologist and academic (I teach and conduct research). Although I absolutely love all aspects of my professional life I am particularly sensitive to how often researchers in clinical psychology pay too little attention to the individual.
There is a focus on getting a general understanding of how this or that scale measure anxiety, depression, ADHD, etc. and test to what extent elevations on this or that particular scale connect with a particular population or group of people. This is not particularly helpful to any one individual because we know there are always complex factors at play for any one individual to feel anxious or develop a personality disorder.
Researchers often find general effects because they compute averages and see how it applies to a vast population. But in therapy, this is of little help. It is all about the specifics of a person’s condition, her connection with the therapist, the personality that has developed over the course of years of life, and other subtle factors.
“We [therapists] may not be magicians… but we certainly are attentive listeners, caring individuals, and carefully attend to details of a person’s life.”
To illustrate the point, let’s take a hypothetical example. You conduct a study with 40 individuals (20 with high anxious/obsessive-compulsive traits; 20 with ‘normal’ anxiety levels) and see if there is a difference between the two group’s GPA score. Let’s say results show that the average GPA score of the low anxiety folks is a 2.9 and the ones with high anxiety is also a 2.9. You may think it is reasonable to conclude there is really no difference between the two types of people.
However, when you look at averages you are really not paying attention to the details of each particular person. What if you look at the data of the low anxiety folks and you notice very little variations among scores but find great score variations with the highly anxious folks? In other words, what if almost all of the 20 low-anxiety participants’ score hover close to the 2.9 average yet half of high obsessivity folks have a GPA of 3.8 while the other half have a GPA of 2.0? The average, in both cases, is 2.9 but they are completely different individuals in terms of their academic success.
Why are they so different? No one can tell until you look at the details of who they are as a person and examine their personality through therapy or in-depth interviewing. It could be, for example, that the ones with a 2.0 GPA are so anxious that they have ‘given up’ on studying while the 3.8 GPA folks are perfectionisticly anxious yet are functional enough they can maintain a high-grade point average.
You can imagine how this manifests itself in therapy. You see a client who is referred to you because their high scores on personality tests are indicative of, for example, narcissism or psychopathy (two correlated personality disorders). So as a therapist, you may begin to see this person with your guards up, careful about how you conduct therapy as you assume this is who the person really is.
But what if, after many weeks of conversations, you notice that in fact the main trait this person exhibits is in fact great anxiety and fear of being hurt? This was, in fact, the case of a young man I saw in therapy years ago who took a battery of tests that made him look like a self-centered person who is at high risk for engaging in criminal behavior. (Note: the tests occurred days following a thoughtless text he had written to a couple of ‘friends’ that worried many). The reality, however, was quite different. But it took months of therapy and a focus on looking at the person in their entirety to appreciate all factors that play a role in shaping his personality.
Some of the most important factors to understand him were: his developmental/family history, his bullied experience during formative years, a lack of connection with friends, and more importantly for this teenager, the sheer panic during the two weeks he was being tested that he was going to be sent to jail, locked up in an institution. A big factor in therapy as well for this young man was his social interaction blunders that came across as threatening rather than a result of a poor ability to connect.
The point, of course, is that it is only through careful observation of the person specifically, that you can get a good understanding of what is going on inside a person’s mind, understand their symptoms. No person can be better positioned to do that than a well-trained therapist, someone who carefully listens to everything a person has to say – both verbally and non-verbally. It is often in those subtle attentive moments that you can uncover big secrets and direct treatment accordingly.
“Although I absolutely love all aspects of my professional life I am particularly sensitive to how often researchers in clinical psychology pay too little attention to the individual.”
Sometimes therapist are accused that such attention to details leads to a failure to look at the big picture and that, in fact, it is not proper scientific methodology. But the reality is that even ‘hard’ science at its very core operates this way.
Kent State University Professor Steven R Brown, one of the best scientists I have ever encountered, explains to me that: “Physicists at Fermilab spend large sums of money and expend much time and energy trying to capture just a few neutrinos when millions of them go through our bodies every second. Some phenomena are elusive and precious on that account, and we should feel lucky if we capture a few of them. We wouldn’t disregard a unicorn if we happened upon one” (email communication, January 23, 2018).
His point, of course, is crystal clear: tiny bits of information or pieces of data that we think are irrelevant may, in fact, be critical in understanding something or someone and can entirely change how we look at things.
We may not be magicians, as one wonderful woman I worked with first believed I was (true story: she thought my last name was Gandalf, from Lord of the Rings, and not Ghandour – the reason why she had agreed to see me) but we certainly are attentive listeners, caring individuals, and carefully attend to details of a person’s life. This is what therapy is about and this is how we are most likely to succeed at significantly improving a person’s mental health.