What I've found to be effective in therapy

Disclaimer: This is a personal account of what has worked for me. I don’t have any clinical experience, nor qualifications to offer prescriptive advice. If you’re determined to emulate what I’ve described here, please bring it up with your therapist first. Perhaps you could even share this post with them. But don’t do anything without their counsel.

Therapists are not allowed to explicitly prescribe the goals of therapy for their clients. In that sense, therapy is a somewhat “surgical” tool that offers interventions for the specific problems that clients report. However, it’s been my experience that one’s psychological issues are interdependent with each other. Being human, most clients are often not aware of the full range of issues afflicting them, nor their interdependency. A good therapist eventually helps their client recognize this. Unfortunately if the client isn’t self-aware of their issues, it may take a lot of weaving and wading through many sessions with their therapist.

I seem to have unconsciously (perhaps with my therapist’s help) found a way to short-circuit this process.

Imagine that you’re a therapist and a man walks into your office. He reports that he’s broken his leg, his wife has left him, got laid off from work and his estranged mum is dying from cancer (with whom he wishes to reconcile). He can see that many meaningful dimensions of his life are in disarray. He tells you that he’s depressed, and wants your help in fixing everything.

Is this man depressed, or is his life a mess? To what extent is he culpable for his current state of affairs? This is an extremely difficult question to answer. On one hand, it’s likely true that he’s been subject to the arbitrary misfortunes of life. It’s simultaneously possible that he’s habituated behavioural patterns that have exacerbated his and everyone else’s suffering to some degree. For example, his mother dying of cancer is unlikely to be his fault. But few relationships ever evolve in a vacuum. It’s possible that he’s contributed something that’s encumbered that relationship and led to their estrangement. Part of his therapy would be to sort out what he’s culpable for and what has simply been bad luck.

Therapeutic progress seems to be proportional to the level of insight contained in the question motivating one’s journey. In some narrow sense, this man is actually fortunate. He knows that everything is broken. He can clearly see the shattered pieces of his life on the floor, and he’s unable to lie to himself about it. Specifying the goals of his therapy is easier than it otherwise would be, because he can clearly see that the scope of his therapy is everything. And that journey of fixing everything, if compounded effectively, might lead him to rapid levels of insight.

The Japanese have a proverb: “The gods only laugh when men pray to them for wealth.” The boon bestowed on the worshipper is always scaled to his stature and to the nature of his dominant desire: the boon is simply a symbol of life energy stepped down to the requirements of a certain specific case. The irony, of course, lies in the fact that, whereas the hero who has won the favour of the god may beg for the boon of perfect illumination, what he generally seeks are longer years to live, weapons with which to slay his neighbour, or the health of his child.

- Joseph Campbell - The Hero with a Thousand Faces

But many of us don’t find ourselves in such extreme conditions. What if you’re not this man? What if you’re a software engineer working in the bay area, making comfortable amounts of money, are jaded with your job and suffering from generalised anxiety and depression? You might have your own notion of what you should ask your therapist. But is that really the most effective question? Is there something better that can be asked, that would accelerate one’s psychological progress?

Universal needs

These seem to be the key dimensions of most people’s lives (whether they’re conscious of it or not):

• Their relationship with the primary actors of their childhood.

• Close friendships that they can rely upon in times of crisis.

• A community of like-minded, growth-oriented peers with whom they feel a sense of fellowship.

• An outlet for their boredom and creativity. That is, a job and a corresponding set of professional skills that are properly fitted to that person’s level of intelligence and temperament.

• A meaningful romantic relationship.

• A meaningful relationship with their dependents, if they have any.

• Lack of rancour, and unconditional positive regard towards the “neutral” agents in their lives. For example, their doorman, the bus driver or the beggar on the streets.

• Healthy boundaries with their “enemies”. Or at the very least, anyone they think is actively frustrating or hurtful.

• A feeling of trust with the world at large.

I’ve yet to meet an adult that’s lived a totally unscathed life. That is, they are in harmony and perfect fittedness along all of the dimensions specified above. I’ve found that most of us have unprocessed trauma styming us along at least one of these dimensions.

Looking back, I’m grateful that I realised early in therapy that my life was suffering along every single one of these dimensions. I told my therapist that I was receptive to getting help for any of the dimensions described above. This maximised the help I was able to get from her. It allowed her to more holistically help me prioritise my therapy sessions.

A passive system to find the gaps

Inevitably, our lives are complex. Such a formulation will have gaps, despite its expansiveness.

I created a rule for myself that if I ever experienced an emotion during the week that was greater than 7/10 level of intensity, I’d prioritise unpacking it in therapy. No emotion arises in a vacuum. Understanding the causes and conditions of all of my strong negative emotions was enlightening.

I made a habit of bringing up these emotions in therapy even if they weren’t relevant to the therapy goals I’d articulated at the time. This allowed me to iteratively broaden my goals to encompass the real issues I was facing in my day-to-day life. 

An active system to find the gaps

Voluntarily exposing ourselves within the limits of our tolerance, to anything arousing anxiety or avoidance seems to be curative. If a patient has OCD, identifying a target for exposure therapy is relatively straightforward. But I suffered from generalised anxiety and depression. A target wasn’t always clear.

So I created a system called my “daily 4 out of 10s”. Everyday, I’d ask myself to list out many of the things I was anxious or avoidant about. That is, what were the things that if I stopped avoiding, my life would get better? Conversely, what were the things that if I stopped doing, my life would get better? I’d calmly ask myself these questions, and my mind would reliably answer without restraint.

This process often generated a lot of possibilities for me. I’d examine all of them and negotiate with myself. I’d pick one thing that arouses a feeling with a 4/10 level of difficulty in my body. I’d then make it my mission to complete this goal that day, no matter what. Some days it would be too hard, and I’d skip it. Over time, I found that 4/10 was the right threshold for me.

Someone starting something like this for the first time would likely benefit from a 0.5/10 or 1/10 level of exposure and work their way up. And perhaps it’d be better to start with an exposure every few days, or perhaps once a week, instead of everyday.

Compound interest is the most powerful force in the universe. He who understands it, earns it; he who doesn't, pays it.

- Source unknown

I’ve been doing this procedure almost everyday for the last 20 months. Each day is an incremental improvement over the truly consequential drivers of my psyche. Over time, this has compounded to something powerful, and I’ve been able to totally rewire my brain. I don’t anticipate that I’ll stop anytime soon. I’ve yet to experience diminishing returns, and I can’t imagine an upper limit to this process.