Why Won't My Therapist Tell Me What To Do?

‘Objectivism’ is the belief there exists a single reality or truth, independent of an individual’s perceptions. In practice, this means whilst we might have our own feelings about something, there is indeed a ‘right way’ to feel or think. For example, if one wants to become a doctor, one must learn a syllabus and demonstrate a predetermined set of skills before they can be recognised as a professional. Moreover, in school, a student is signified as competent when they have absorbed a curriculum and reproduced it to the institution’s criteria. 

Objectivism permeates the world of mental health. For instance, in the cognitive-behavioural modality there are a set of cognitions and behaviours that are considered healthy. These healthy behaviours include positive self-concepts, physical activity, consistent sleep, resilience and sociability that must be assimilated and practiced by the individual. 

Moreover, in the world of psychiatry, robust mental health is contingent on one’s organic matter. That is, one’s suffering is because of a deficiency in their brain chemistry, corrected using psychiatric medication. 

Alternatively, in psychotherapy, truth is not seen as something ‘out there’ to be taken in by the individual. Rather, truth is seen as subjective, produced by the individual. In this way, words are not treated as something to pathologise but instead are necessary to understand the particular meaning the patient gives to their own lives. By speaking and producing their own discourse, the client/patient notices patterns permeating their speech, making what is unconscious conscious, and uncovering the unique way they relate to the world. 

In this sense, the psychotherapist does not tell the patient what to do because they cannot tell the patient what to do. To put it differently, the psychotherapist does not have the knowledge, the patient does, and this knowledge is to be discovered in the treatment by maintaining a position of curiosity to the patient’s symptoms. This might take time – perhaps years – and this is to be expected: the pursuit of subjective knowledge starts at square one with each individual and does not have a head-start from objectivist or pre-determined grounds. 

Let us turn to an example: I once saw a patient who turned up late to sessions and when she tried to speak, her speech was hesitant. She routinely asked me how I was and made comments suggesting practising psychotherapy must be arduous. Eventually she spoke about her early experiences as a carer to her family and revealed her difficulties in occupying the role of a patient – the object of care. It materialised that the ‘arduous’ comment reflected herself and the resentment of the role bestowed upon her. By extension, in the role of the patient she saw herself as a burden.

Shortly after the disclosure, the patient spoke more freely. She was unshackled from the transference and could use this rupture to take up a position of curiosity in relation to her symptoms. Moreover, she could identify how this dynamic was reproduced in other areas of her life, putting her into a place where she could think differently about the subjective positions she took as a given. Consequently, the patient gave herself room to breathe from her symptoms and in doing so was able to allow herself to experience her relationships differently. 

Psychotherapy is a means rather than a supplier of knowledge. By taking this position, something about the subjectivity of the patient is allowed to be revealed, leading to personal and unique solutions. This is not to say that objectivism does not have its place, but rather there is something individualised about the suffering of our patients that escapes attempt at objectivism. To capture this, we can turn to psychotherapy to pursue subjective knowledge, a process that emphasises listening and curiosity whilst resisting instruction and certainty.