Psychotherapy is hard to study. It’s particularly hard to study what it is exactly that helps people in therapy get better. Some schools of thought, like psychoanalysis, are uncomfortable even declaring therapeutic aims to be the primary consideration of the analyst. I argue that outcome is the only thing that should matter to us, as therapists, and that there are few universal principles of technique that we can rely on to judge whether or not something that we’re doing is helpful or not. Therapists have to ruthlessly analyze and judge their patients’ responses to their interventions. If a patient leaves sessions feeling misunderstood and isn’t getting better over time, then the therapist is responsible and needs to change his or her approach.
The Happiness Trap is a self-help book written by Russ Harris and is based on the ideas of Steven Hayes who developed Acceptance and Commitment Therapy, or ACT. ACT is based on the premise that our attempts to fight or flee from uncomfortable feelings create most of our problems. Our culture, too, is filled with images that suggest that the good life is one without any distress. This is impossible and our attempts to subtract any and all forms of unhappiness are doomed and leave us unsatisfied. Instead, ACT urges us to be mindful of our thoughts without having to buy into them and, instead, to attempt to live our lives in ways aligned with our values.
Psychotherapy can be understood as the process by which the therapist and patient work to disconfirm the pathogenic beliefs that the patient acquired growing up, beliefs that cause the patient to feel distress. One of the central ways that this occurs is through testing. There are two kinds of tests—transference tests and passive-into-active tests. In transference tests, the patient experiences the therapist as if the therapist was a problematic parent. In passive-into-active testing, the patient enacts the role of the problematic parent and assigns the therapist the role that the patient was in as the child of that parent. Examples are given of each type of test. In each case, the patient gets better if the therapist contradicts his or her assigned role. If the therapist re-enacts the patient’s childhood relationships, then the test is failed and the patient doesn’t get better.
People act against their own self-interest all the time. This is the stuff of psychotherapy. But people also vote against their own best interests. For example, white working class Trump supporters have not benefited from his Presidency and, in fact, many of them have been hurt. Progressives have to use a deep type of empathy to understand such self-defeating political behavior. Many white working class men feel left behind in the rush toward automation and globalization, and experience government as insensitive to their needs. Instead, fueled by racial and ethnocentric bias, they see people of color, including immigrants as getting favored status—a type of “cutting in line” that sociologist Arlie Hochschild has studied. Progressives have to challenge this distortion while empathizing with its painful consequences.