When All You Have is a Hammer: Why Counseling is not the Answer

Photo by Steve Johnson from Pexels

*note: I used the words counseling, psychotherapy, and therapy interchangeably

I see a certain kind of counseling client that on the surface appears to have nothing wrong in their life. Often, they have good paying, white collar jobs, live in low crime, moderately high-income communities. They own their homes, have reasonably active social lives, and have access to all the comforts and privileges attached to life as a middle class American.

According to mainstream culture, they’ve made it. They should feel good, but instead have severe anxiety and panic attacks. The pain they experience is in fact very real and debilitating.  

Often, they are given a diagnosis of Generalized Anxiety Disorder – pervasive and excessive worry about several areas of ones’ life.  As therapists we are tasked with developing strategies to reduce their overall anxiety.

I wonder though, whether that anxiety is really a sickness to be cured? I imagine it to be like a smoke alarm for the soul, warning them that their house is on fire. In this regard, therapists serve as the oddest kind of fire brigade. Rather than putting out the fire (the source of their anxiety), we walk into the house and help them take the batteries out of the alarm so that they can get back to sleep. If the anxiety continues to sound the alarm, a referral to psychiatry is indicated and they are given a prescription. The medication lulls them to sleep, the therapist tucks them in and tells a pleasant bedtime story.

Sadly, many of these folks are not really living, but limping through life.

With the general decline of community, therapists have stepped in to meet the psychological, mental, emotional, and spiritual needs of the people. Counseling is often held up as a panacea for what plagues the individual. It is the confidentiality of the confessional booth, the non-judgmental listening ear of a best friend, and the credentialed, well informed advice of a medical professional all rolled into one.

From personal experience, I can say counseling can be all these things and more. Some people walking through the doors of the clinic find exactly what they need and are looking for. Yet a higher number of people do not find what they need or only find a piece of the answer they seek. Tiny crumbs pointing to a larger feast elsewhere.

That is because counseling is a highly specific and time constrained process that is overused for issues well outside its scope. It can also serve as a band-aid for deeper underlying issues, many of these counseling was never intended to address.

“You should talk to a therapist,” friends advise. When all you have is a hammer, every problem looks like a nail.  

***

The current mainstream model of how we deliver mental healthcare, specifically psychotherapy, is outdated and unravelling. It is designed for provision within an affluent, consumeristic, and highly individualistic society. There are still elements of psychotherapy that are useful and necessary, pieces that can bring change and healing to people, but much of what we do needs to be rethought, redesigned, or tossed out entirely. Generally speaking, the system is unable to meet the needs of our era.

Deep breathing techniques, writing down your thoughts, going outside or spending more time with people – our prescriptions can often feel like giving multivitamins to cancer patients. We cover these suggestions in ‘medical speak’ to increase our sense of legitimacy: “increase socialization” (spend time with people), “cognitive restructuring” (thinking more positively), “identify maladaptive thought patterns” (list the ways you think negatively).

We administer questionnaires to assess if a person meets the clinical threshold for a depressive disorder or anxiety. When the questionnaire score drops below a certain number, the person is considered “in remission” from their mental health issue.

But this raises the question, for those of us in the healing professions, what is the aim of our efforts? Is it merely symptom alleviation or wholeness?

*** 

There are three large areas of the human experience that psychotherapy based on the medical model fails to adequately address: (a) the need for community, (b) service to others, and (c) purpose in life. There is a tendency in the current model to see someone as an individual collection of symptoms, whereas many of the issues we see in practice are but the individual expression of a larger societal pathology. As a friend of mine said, “We are trying to solve a collective problem individually.”

The Three Areas

Need for Community

Consider the following patients. The first comes to sessions indefinitely and yet never seems to thrive. They’re not really in crisis, but you wouldn’t say that they’re living their best life either. By coming to regular sessions, they can maintain their personal status quo. Yet, if allowed, they would remain in therapy for years or even decades. Counseling has become a fixture in the makeup of their life, rather than an intensive and time constrained process. This person has genuine and important needs. They are desiring companionship and camaraderie, they want to feel connected to others. Therapy promises to be a solution, but that promise is illusive.

Another client lives alone or has an otherwise weak social support system. This person comes to therapy for treatment of so called depression and benefits greatly from the sessions. They feel better after the hour is over, yet as soon as the session ends they return to their lonely and isolated existence. Nothing really changes. Therapy is a once weekly psychological shot in the arm to make it through the week.

As COVID drags on and more broadly, as society moves more of our social interactions to virtual platforms, this person becomes increasingly isolated. They fall through the cracks of society. I could tell them “go out and meet more people”, but where would they go?

Where do hurting people go to meet authentic healing community in this time?

Service to others

A body of water requires an inlet and an outlet, otherwise it will become stagnant. Psychotherapy is an important input for people who are hurting or in need. The time spent in sessions being listened to and asked good questions can provide a big boost to clients. And yet, at some point, this can also be taken too far. In our consumeristic and highly entitled society, where there is an exchange of money for services, therapy can sometimes digress into nothing more than a mental massage. The client pays money, “blows off some steam” for an hour, and goes about their day. This arrangement is not in the best interests of either the client or the therapist.

Therapy is conducted behind closed doors, in silos of secrecy, rather than connected to some larger whole. Because it is one on one, there is rarely a component requiring the client in treatment to also be actively serving the people around them in some capacity.

However, suppose therapy were happening within the context of a larger group, and instead of billing insurance for individual services, counselors gave generously of their time and energy with the expectation that clients would pay it forward to the community.

In east Asian cultures, parents and family members expect a certain return on investment from their children and members of the community they’ve poured into throughout the years. It is a far more collective mentality. Perhaps it is time, that we begin to expect an ROI from our clients as well.

Americans are often uncomfortable with the concept of “obligation”, as it can feel like an old-world anachronism and an impediment to our individual freedoms. We much prefer the model of exchanging money for services, with no strings otherwise attached.

But expecting clients to make a contribution to the larger whole as a prerequisite for counseling is a form of empowerment. It puts collective pressure on them to grow and is also an expression of our faith in their ability to change. By requiring that persons entering counseling engage in service within their immediate context, we place the expectation on them for long-term success. This also enables them to share the knowledge and experiences they’ve gained from the therapy process.

Purpose

Sadly, we don’t spend as much time in therapy talking about the meaning of life as I’d like to. Many are so buried under the weight of busyness and noise that there is little room for contemplation. Often the deeper questions about life, death, legacy, and purpose are left buried in the unconscious mind.

Yet those deep questions are always churning just below the surface. The unconscious turbulence bubbles to the surface and manifests in a number of ways. For many of my men clients, it is a nearly pathological focus on work, careers, and outward achievements. These prop up the false identities that supposedly give our lives meaning.

However, when a person’s mind senses they are heading down the wrong path, anxiety is often produced to warn them. They may be ignoring one of the above-mentioned needs (community, service) or they may fear the risk of heading down a different path in life.

Commonly, the person will try to medicate away the tension of this experience using social media, work, alcohol, drugs, sex. This constant inward focus only increases a sense of purposelessness. They take in the message that life’s meaning is only in what you produce (achievements) and what you consume (medicating).

Popular culture, bombarding the person with advertisements telling them what they lack and where to buy the solution, only reinforces this cycle. In this situation, counseling runs the serious risk of being just another form of consumerism, something to try out and if it feels good, stick with it.

***

The need for community, opportunities for service, and finding a purpose for life – these are all large areas of the human experience that psychotherapy fails to adequately address. In fact, the experience of counseling is often the opposite.

Rather than community, we focus on the hyper-individualism of self-analysis and diminishment of personal discomfort.

Rather than therapists giving their time and talents in exchange for clients making a larger contribution within the community, we focus on payments and reimbursements. There are insurance deductibles to be met and copays to be taken care of. We are subtly and not-so subtly incentivized to keep people sick. In this messy exchange of currency for services, nothing can be reasonably expected of our clients. 

And finally, rather than finding a deeper purpose for life, counseling becomes just one more dish available on the buffet of consumerism that our society daily dines on.

But, as the old way of doing things continues to unravel, imagine something new and different springing up in its place: we solve individual problems collectively.

A community of people on a similar path helping each other along. As they grow together and serve out into their communities – families, workplaces, places of worship, places of recreation – real and deep healing begins to occur. Within the context of a group and with a steady outward focus on serving others, people begin to find meaning in life. Something bigger than themselves. Depression lifts, anxiety evaporates, and the smoke alarm of the soul truly quiets, telling us the danger has passed.