Sooner or later, if you come to me for therapy, I’ll ask you to put, in a single sentence, your objective in seeing me. I ask this because I want to know how to be successful. I also want you to define your goal. The most common answer I get is something like, “I want to know why I am the way I am.” In other words, why do I drink more than I should, why can’t I get the courage to leave my husband, or why am I so depressed, so anxious, or so angry? I used to be surprised by this, especially if it came after a long, intense description of how unhappy they were. Wouldn’t they rather know how to stop drinking, how to be less depressed, anxious, angry, or how to leave their husband. Why ask why? The insurance company, which may be paying for most of your therapy would rather you asked how than why. How can be answered in a few sessions. I could teach you the principles of relapse prevention, symptom management, cognitive behavioral therapy, dialectical behavioral therapy, mindfulness meditation, relaxation, conflict resolution, or refer you to a divorce lawyer without even getting to know you. I may not need much training or be especially skilled or wise to teach you how. It could all come from a book or a YouTube video. In fact, you might not even need to see me at all: you can buy the book or stream the video and save your insurance company a lot of money. Why is a harder question, one that cannot be answered in brief therapy. Psychotherapy researchers would rather you asked how than why. When you ask how, success or failure can be more easily measured. Either you stop drinking or you don’t, you get up out of bed or you don’t, you get on that plane or you don’t, you bust another hole in the wall or you don’t, you get a divorce or you don’t. When you ask why, we can never be sure we’ve gotten the true answer. Are you the way you are because of early weaning, genetic determinants, cultural influences, racism, sexism, peer pressure, individual choice, or sheer laziness? The answer is probably yes, all of them to some degree, and more. But, even if we get an answer, how will we know when we find it? Psychotherapy researchers have no patience for that. It’s publish or perish for them. Consequently, no therapy that asks why will ever be listed as “evidence-based” therapy in the way they often define it. Insight-oriented theories cannot easily be falsified, confounding variables cannot easily be eliminated, and results cannot easily be measured. Psychotherapy researchers would rather do what’s easy. Employers of therapists, those big head-shrinking conglomerates like I used to work for, would rather you asked how than why. They can hire less experienced therapists, pay them poorly, and be assured of a standardized product if the focus is on how, rather than why. They’ll be on good terms with insurance companies and be able to point to statistics of success. They’ll keep you moving into brief treatment, out of treatment, and often back into treatment with a new therapist so that your brand loyalty is with the clinic at large, not with an individual clinician. With how, you are just another widget, in for standardized repairs. When you ask why, there is no way you can be treated in any way other than as a complex, unique individual. Given these difficulties, why do people ask their therapists why, when they could be asking how? Why would a therapist entertain why as a question? Are there any good reasons? You want to have a name to call the problem Of course, why is a question that only leads to more why questions. If I say that you can’t get up in the morning because you’re depressed, you can Google it and get all kinds of tips to deal with depression. You can go to your doctor and know what drug to ask for. You can take solace that you are not just lazy but have a treatable disease. But it’s only a matter of time before you ask why you are depressed. What causes your depression and why do you have it when others don’t? Why is a question that goes all the way down and never ends. You just need to tell the story of your problem, but you can’t find anyone who will listen You don’t want to change anything yet; you just want to understand it The woman who wants to know why she doesn’t have the courage to leave her husband should probably ask why long before she asks how. If she doesn’t know the part she plays in her marital problems, she’ll just leave that one relationship, only to end up in another just like it. If you knew why, then you’d know how You believe that why is the answer I can give. You don’t think I can tell you how I have to admit that many of the stereotypes about therapists are true. We are largely an impractical bunch. We seldom have a payroll to meet. When we’re asked to be accountable, we raise an unholy ruckus. Our walls are lined with diplomas and books. Some of us actually write books, so I think it’s fair to say we are book people. We ask a lot about history. We’re obsessed by context. Moreover, we can’t answer how your problem is going to change because we don’t know what it will take to change. Many of our interventions are hit or miss, our suggestions are misunderstood, our recommendations are ignored. We haven’t studied success like we’ve studied problems. When patients are successful, they leave, so we often don’t know what worked, or even if anything worked. Why is the sound ambivalence makes Let’s take the guy who must stop drinking. There’s no real point in developing a plan to stop drinking when he still does not have the motivation to do so. But it is OK with me if he comes to therapy to ask why he drinks. That will occupy us while he sorts it out. It could sound like he’s looking for an excuse to drink, except that, in asking why he drinks, he’s also asking why he doesn’t stop. Asking why he doesn’t stop drinking is as good a question as asking why he drinks at all, and it is a question that lets him imagine a life without drinking. So, you see, there are lots of good reasons to ask why, rather than how. I’ve come to accept why as an answer when I ask about goals and objectives. Now, if insurance companies, researchers, and employers of therapists could be more accepting of why, then clients would get the kind of care they want and need. They won’t have to keep coming back when only asking how doesn’t work for them. Invite your friends and earn rewardsIf you enjoy The Reflective Eclectic, share it with your friends and earn rewards when they subscribe.
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Monday, 7 April 2025
Why Ask Why?
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