No Therapy is Absolute or Final. However…


In November 2011, I attended an extremely helpful workshop entitled “The Lost Art of Psychotherapy.” The presenter was Barry J. Koch, PhD psychologist, professor, and author at Newman University’s Master of Social Work program in Colorado Springs.  What may come as a surprise to clients in counseling and psychotherapy (perhaps even some therapists), Dr. Koch ended the workshop with the following caveat:

“There is no such thing as doing a ‘complete’ job in psychotherapy.” 

Although research has consistently shown the efficacy of counseling and psychotherapy, I have never forgotten Dr. Koch’s words. Attempting to briefly qualify that caveat is the subject of this blog.

In her groundbreaking classic, Trauma and Recovery (1992, 1997, 2015), professor of clinical psychiatry, emerita, at Harvard University Medical School, Judith Herman, MD offers a fitting response. Although addressing the issue of trauma specifically, Dr. Herman speaks insight into the nature of counseling and psychotherapy generally:

“Resolution of the trauma is never final; recovery is never complete. The impact of a traumatic event continues to reverberate throughout the…lifecycle. Issues that were sufficiently resolved at one stage of recovery may be reawakened as (one) reaches new milestones in her development.  Marriage or divorce, a birth or death in the family, illness or retirement, are frequent occasions for a resurgence of traumatic memories….

(A) patient was humiliated by her need to return to psychotherapy. She feared that the return of symptoms meant that her earlier therapy had been a failure and proved she was ‘incurable.’ To avert such needless disappointment and humiliation, patients should be advised as they complete a course of treatment that post-traumatic symptoms are likely to recur under stress….The patient should not be led to expect that any treatment is absolute or final (italics mine). When a course of treatment comes to its natural conclusion, the door should be left open for the possibility of a return at some point in the future.

Though resolution is never complete, it is often sufficient for the (person) to turn her attention from the tasks of recovery to the tasks of ordinary life. The best indices of resolution are the (person’s) restored capacity to take pleasure in her life and to engage fully in relationships with others. She has become more interested in the present and the future than in the past, more apt to approach the world with praise and awe than with fear” (pp. 211-12).

“Though resolution is never complete, it is often sufficient for the (person) to turn her attention…to the tasks of ordinary life.”

A few pages earlier, Dr. Herman similarly writes:

“…the moment comes when the telling of the trauma story no longer arouses quite such intense feeling. It has become a part of (one’s) experience, but only one part of it. The story is a memory like other memories, and it begins to fade as other memories do. (It) begins to lose its vividness….

At first these thoughts may seem almost heretical….And yet she finds her attention wandering back to ordinary life. She need not worry. She will never forget….But the time comes when the trauma no longer commands the central place in her life. (A) rape survivor…recalls a surprising moment in the midst of addressing a class on rape awareness: ‘Someone asked what’s the worst thing about being raped. Suddenly I looked at them all and said, the thing I hate the most about it is that it’s boring. And they all looked very shocked and I said, don’t get me wrong. It was a terrible thing. I’m not saying it was boring that it happened, it’s just that it’s been years and I’m not interested in it any more. It’s very interesting the first 50 times or the first 500 times when you have the same phobias and fears. Now I can’t get so worked up any more.

The reconstruction of the trauma is never entirely completed; new conflicts and challenges at each new stage of the lifecycle will inevitably reawaken the trauma and bring some new aspect of the experience to light. The major work of (therapy) is accomplished, however, when the (person) reclaims her own history and feels renewed hope and energy for engagement with life. Time starts to move again” (p. 195).

That 2011 workshop did conclude on a similar note. Quoting Dr. Koch: “The goal of psychotherapy is to help (one) get to the point where he or she feels (some control) over what has previously threatened to overwhelm them.” And when that happens, therapy may not be absolute or final, but “time starts to move again.” 

Bill Bray, Colorado Springs, CO

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