Process, Outcome, & Healing
In psychotherapy, the process is the outcome, and why general advice is seldom useful
Fix My Problem
Often when a person sees a therapist for the first time, an instinctive question clients ask me in the first session, is “what should I do? Now that you know what’s going on, how do I solve this problem?”
While it's common for our pop culture to treat therapists as pseudo-gurus who seemingly have all the answers, this post may act as a reminder that we too are just human, and we don't necessarily have the “right” answer, or even an answer at all! But that’s okay, and in fact, having the answers is not actually the end goal of therapy (gasp!).
I think this desire for getting clear answers and doing the “right thing”, speaks volumes about society's emphasis on us having to know what to do, all of the time, and feeling behind or feeling that something is wrong, if we don't know the direction of our lives, or what the “next step” looks like for us.
I sense this speaks to our collective insecurities towards things like nuance and ambiguity (see: political debates), but the complex and heavy feelings underneath this nuance can perhaps also be celebrated (it's okay if you’re feel stuck! It definitely doesn’t feel good, but its okay, and nothing is wrong with you for feeling these feelings). Even us therapists at times get caught up in this trap of solving, of wanting to help “fix” their clients problems, but inadvertently we can drive our clients in a direction where the client might not be prepared for, or even want to go, and this whole process undermines their agency and ability to find their own answers.
In a world of ever increasing polarization, we are often primed to look for the “right answer”, over the fear of being “wrong”.
If I feel like I'm not doing something right, I must be doing something wrong. If I haven't found an answer yet, maybe I’m not looking hard enough. If the advice of other people around me doesn't resonate, maybe there's something wrong with them, or worse, maybe there’s something wrong with me…
When clients bring the question up to me (“What should I do?”), I see it as a genuine desire to use knowledge, practical advice, and understanding as a tool towards some actionable steps — to fill the gap somewhere in our lives in a way that will “fix” the problem. Ultimately, the client wants to go from “the stuck place” (here), to “the unstuck place” (there).
Underneath this, I recognize there may be a deeper struggle with issues that the person has been dealing with, for perhaps a very long time. A complex problem typically involves a lot of moving parts, and the complexity and nuance of the problem is probably why there are no easy answers in the first place. None of this helps with the feeling of helplessness and the overwhelming burden of shame that might come with feeling directionless, all of which can lead the person feeling more paralyzed and lost.
If the problem was simple enough to have a straightforward answer, or if the person could work towards a solution themselves, they likely would have received plenty of actionable advice from the internet, books, friends, and family on what to do, and would not feel stuck and be in therapy, in the first place!
This isn't a judgment call on the person for going to therapy, by the way, but quite the opposite (something to be praised). So often when we reach out to others or search for answers, we are doing so out of desperation because we feel we lack agency to come to a reasonable conclusion — we don’t know what to do. Often, the person might even put themselves down for going to therapy (“If I am in therapy, what is wrong with me?”).
Naturally, the person might feel some level of hesitation, stigmatization, vulnerability, and even desperation. These feelings and their associated judgments about oneself can be quite strong, and sometimes we search for answers and actionable steps so that we can at least temporarily escape from the purgatory of self-doubt and overwhelming paralysis.
Maybe doing something temporarily hushes the strong inner voice and critic inside of us, but we’re still left being uncertain about the future, or left feeling stuck with a cluster of emotions. Eventually, we might find that we fall back into trying to solve the problem by reverting back to doing something.
That is, we might find that we can temporarily alleviate an issue by learning more about why we do it, exploring what our triggers are, or even brainstorming what we “should” do, but we might find that this is mostly a mental gymnastics exercise that maybe bandages a deeper, more persistent issue.
This ambiguous feeling of being stuck, without direction, without guidance, without support, and perhaps even without an acknowledgment of your own emotions, is such a strong internal force, that we will seek some answer, any answer, in the hopes we can attain some temporary comfort. But by working through some abstract, mentalized version of the problem, stripped away from our emotions and intuitions, we might find that we are also separating our own selves from the problem, and maybe missing the point, entirely.
Process & Outcome
Often, when we speak of processes and outcomes, the process of something is supposed to lead to a better outcome.
If I have a stomach infection and go to the doctor, they might prescribe me some antibiotics and send me off on my merry way. The process (going to the doctor and taking my prescription), leads to an outcome (feeling better and healing from the stomach infection).
The same is the case for physiotherapy. If parts of my body are weak, tight, sore, or injured, the therapist might instruct me to regularly exercise and stretch certain parts of my body to heal from the injury, and adapt the body to make it more resilient. Physiotherapists are very much “pro-doing”, and it makes sense why that is. The body adapts to its surroundings, and if it is not moving and doing, then it starts to break down and worsen existing injuries.
Doing something about it, seems to be the answer for most problems, in most healing settings. Naturally, mental health therapists then get the reputation that we must also have the correct answers to the very nuanced and complicated issues that clients bring to us.
Because if we don't have the answers, then what's the point?
Process As Outcome
The internet is full of unsolicited advice. A quick search on YouTube brings up dozens of videos of YouTubers giving you “10 quick tips” on how to procrastinate less, or how you can make money fast with e-commerce and dropshipping, or how you can get six pack abs just in time for the next summer, or how you can escape from feeling depressed. The list goes on.
The obvious, but nonobvious point, is that everyone is different. The reason we procrastinate is different. Our skills and ability to make money are different. Individual metabolism, lifestyle, and genetic factors are different. The reasons we feel stuck and depressed in our lives, are different.
If the causes are different, the feelings are different, the blockages are different, and how we adapt to these blockages is different, then what we need to ultimately feel better and overcome our problems, is also also going to be different! Meaning, given that there is no one way of doing the “right thing” (in psychotherapy, there is no one right way to “heal”), a lot of actionable advice floating online under the guise of blanket statements of what is “right” and “wrong”, simply won’t work for everyone. Some diets work better for some people than others. Some exercises are rehabilitative for some people while they can worsen existing injuries in other people. Normally, it's pretty rare that you have only one correct answer that is applicable to every person, in every situation. The individual struggle, is figuring out what the answer looks like, for you.
Now, this doesn't mean that knowledge is not power. For some folks, maybe they been struggling with mental health issues their whole life, but getting a formal diagnosis, or learning more about the complexities of such a condition, might empower them towards a better understanding of their symptoms, and ultimately work towards some change.
If something is not measurable or observable, then it can't really be tracked, and its harder to determine what progress is, or even looks like. Having a direction or goal-post can help. Thus, here, maybe having some knowledge and gaining some understanding about a complex problem, might be a good place to start.
The issue, I think, is that Google and the Internet at large has allowed for unguided self inquiry (a very good thing), but it also places the onus onto the individual to figure out what is signal (real, good, useful information), and what is otherwise noise (potentially harmful, bad advice). The Internet is filled with people trying to sell you a product or service, and is riddled with a lot of conflicting advice and misinformation about “solving” your problem, which might make you feel even more lost and confused.
This kind of open, inquisitive, nonjudgmental self-exploration is seldom achievable alone, and Google isn't seemingly the best tool (maybe personalized AI assistants in the near future might help). It is very difficult to find someone outside of our own lives that can help facilitate such a process for us. Hence, counselling and psychotherapy can provide the space to be ourselves, without the urge to do something. I believe this unconditional acceptance from another person is potent enough to merit being both the process (the therapy session) and the outcome (healing).
Through this lens, a rare gift of psychotherapy, one that few other healing domains in the world can help facilitate, is that it doesn't shy away from stating that the process is indeed the outcome. The ends don’t have to justify the means, because the means are itself the end goal.
Meaning, in psychotherapy, there is no urgency to do, there are no “should” statements, there is no quick fix, and there is no singular “right way” of healing. This is bad news for a lot of us, because we’re so used to getting a quick fix for most of our problems. Given that we as a society are very outcome-driven, the desire to produce some sort of tangible result is present in pretty much all areas of our lives. This can be overwhelming and daunting for both client, and therapist (we are all humans, after all). But starting with the humility that we, including therapists, don't have all of the answers, might just be the state within which we can surrender ourselves to our emotions with unconditional curiosity, and give ourselves permission to heal through the process. Who knows, this might just be an important pre-condition to getting “your answer”, but the process will take a bit more effort than a few google searches :)