Thursday, May 10, 2012

Therapy Does Not Equal Rent a Friend

“I don’t need therapy, I have friends”

This is a sentiment that is frequently expressed.  However, this is not the reality that I generally see among my clients. While it is true that I often perceive that my clients could strengthen their social support networks, they do not come to therapy to share their mundane problems—that is what social support systems are for. Rather, they come to me with enduring or intense problems that they feel for which their support systems are inadequate.

A concern that I often hear from clients is that they do not want to overburden their support systems. I think most of do not like friends that are constantly complaining—most of us also do not like to be the friend that is constantly complaining. We do not want to be perceived as an embodiment of our problem, but to be seen for the multidimensionality that we are. As a consequence, we often withhold some of the pain we are experiencing from our friends in order to appear to be “bigger” or more than the pain. We want out friendships to be a balance of support and entertainment-companionship.

When a problem is enduring and personal it is difficult to constantly have ‘the problem” as the context in which one interacts with friends. Friends are often well meaning in asking about a problem, but rather unprepared to deal with the full brunt of the problem. They also do not understand that by asking about a problem, while they intend to be supportive and are genuinely interested and concerned, they actually help keep the problem in the forefront of the person’s mind. Sometimes we want our friends to offer us support as a “time out” from the problem.

Friends also lack the ability to be objective. Friends have insight that a therapist never will, however, they also have their own filters as well. Friends are also are rarely free of their own agenda. When a therapist develops an agenda for a client it is grounded in an understanding of the client’s best interest. While I genuinely care about the happiness of my clients, at the end of the day my life will largely be unaffected by the outcome of a client’s decisions. Friends are frequently affected by friend’s decisions, and are aware of this. Therapists are able to be outside, independent observer in a way that friends can never be. Friends also recognize that by being too challenging of their friends they can endanger the friendship. As a therapist I get more liberties to challenge people about their problems and call “bullshit” when I see it.

Sometimes clients come to me because they do not feel safe talking to their friends about their problems. If the problem is about a friend and one is not sure how to address it or is uncertain about the problem in some way, then talking to the friend about the problem is not likely to feel comfortable. There are also things that we would rather not have our friends know about us. While I am not a big fan of secrecy, it is a reality of many people’s lives—as is privacy. Sometimes there are things that we would like to better understand before we are ready to share with friends—or even know how to share with friends. One of the reasons people come to therapists is because we are trained to deal with the heavy shit—questioning the existence of god/good/evil, feeling life is meaningless, questioning one’s gender/sexual orientation, figuring out what roles one actually wants in society—these are not questions that most friends are prepared to deal with and can only give pat advice.

Friends also are not trained in theories of personality, human development, symptom identification and treatment, and processes of human change. Therapists are. Listening to problems and being supportive is an incredibly important role of friendship. But listening to problems and being supportive is not facilitating change or personal growth, actually it often facilitates the status quo. Therapy often provide and educational or normalizing role that friendship cannot—either the friends do not have the knowledge or they will be trusted as unbiased.

I cannot overemphasize the importance of a social support system. In fact it helps feel keep us stable and from sinking into poor mental health. But friends cannot offer the same professional guidance and exploration (not advice) that therapists provide.

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