Three Words Therapists Do Not Speak: Strength of Will

512px-RIAN_archive_497570_Weight_lifter_Sultan_Rakhmanov

Imagine a game in which you alone determine when play begins and ends. Although not an easy contest, you get to set the goals and mark the finish line. You can interrupt the match whenever you want and restart later if you wish. The game may last a long time or a short time, but you are assisted by another player who will help your cause.

Now guess the name of the game.

Psychotherapy.

As I’ve described it — and I hope you agree — there is no opponent other than the one you face daily in the mirror. Then why is “the talking cure” so hard?

Lack of willpower is one of the reasons. And, ironically, strength of will (or rather, its absence) is the one least discussed with patients.

Counselors don’t talk to clients about will because doing so sounds critical and blaming, as well as being unhelpful. Examples? “You need courage. You must push through.” Or, worse yet, “man up.” In practice, that means tolerating the emotional pain of facing yourself and uncovering difficult truths about yourself; spade in hand, excavating excruciating memories you’ve dismissed or buried. It presents one of the greatest challenges any of us ever face: change.

Therapists are also hesitant to admit their own lack of all the tools to heal. Yet, we are helpless without your motivation, persistence, and courage. If you dodge self-revelation, keep your barriers high, are unwilling or unable to try new things, don’t show up faithfully to appointments, fail to give negative feedback when necessary, don’t bother to do therapeutic homework between sessions or think carefully about what happened in the meeting — well then, the doc’s job is hard if not impossible.

Sports metaphors come to mind: “the team that wants victory more will win.” Or, “we must give everything we’ve got.” Green Bay Packers coach Vince Lombardi encouraged his players by saying, “Winning isn’t everything. The will to win is the only thing.”*

Even military examples apply. In criticizing a recent failure of the Iraqi forces against the Islāmic State (ISIS or ISIL), US Defense Secretary Ashton Carter said, the Iraqis had “no will to fight” despite vastly outnumbering the enemy.

A psychiatric mentor of mine called the presence of this will, “therapeutic integrity.” With those two words he was referring to people who stop at almost nothing to improve their lives, sometimes leading the treatment by their own self-exploration and risk taking — demonstrating tenacity and quiet determination. This is not a question of fear, but rather of heroic triumph over fear. Indeed, some wonderful models of this characteristic don’t even realize they exhibit anything special.

An example: a middle class, middle-aged woman suffered sexual and physical abuse in childhood, and was much criticized as an adult — to the point of becoming the family scapegoat. Psychiatrically hospitalized, the exposure of painful repressed memories of her abuse contributed to a brief catatonic state in which she was mute. After a long process of treatment she went from terrible guilt and depression to recognizing and grieving what had been done to her by those she loved. Eventually, this person (who had been fearful of noises and male strangers) wound up providing humanitarian aid in Africa in the midst of a civil war.

She had therapeutic integrity. Heaps of it.

512px-Weight_lifting_black_and_white

This doesn’t mean the lady didn’t falter or struggle. It doesn’t mean she had no issues with her therapist (me) or an easy time when I went on vacation. It means she “hung in” until she was where she wanted to be. I don’t know whether my client was gifted with resilience due to her genetic makeup. On first encounter her voice was quiet, her body language suggested timidity, her eyes downcast. She was bolstered by a powerful religious faith, but did express temporary doubts about a superior being who would permit what happened to her. Somehow she found strength in herself beyond a therapist’s ability to create.

Not every patient must possess great amounts of intestinal fortitude. Not every person’s durability is stretched to the limit by the arduous road bringing him to treatment and by the therapy itself. Sometimes, however, the presence of “will” is the difference between success and failure of the heroic assault against psychopathological demons.

I don’t blame those who can’t find this quality. Sometimes the therapist is at fault for lacking skill. I think it another one of life’s inequities that resilience is not evenly distributed. I tried to enable everyone in my practice to find this ability.

Many times the resilience seemed to take forever to retrieve. I looked hard for the tiniest of eggs fertilized by a therapeutic spark. No matter how small the egg, with progress the zygote of willpower grew. On other occasions dedication in the face of terrible odds wasn’t anywhere to be found.

In the consulting room, alone with the therapist, you are pitted against yourself. No enemy is fighting you but what is inside, the echoes of past defeats, the injuries still fettering you. I won’t criticize you if the steam roller of the world flattened you and left you unable to get up. I only know I never succeeded in lifting anyone who didn’t (at least in some small part of himself) want to be lifted or who required me to do the heaviest part of the lifting.

Norman Cousins said, “Free will and determinism are like a game of cards. The hand that is dealt you is determinism. The way you play your hand is free will.”

Ralph Waldo Emerson put it this way: ”They can conquer who believe they can. He has not learned the first lesson in life who does not every day surmount a fear.”**

The game is over only when you say so. That is as much control as any of us get.

*Actually, there is some argument whether Lombardi wished to say precisely this or something close: “Winning isn’t everything; it’s the only thing.”

**The italics are mine.

The top photo is of Sultan Rakhmanov in a 1980 weight lifting competition. It is the work of Vitaliy Saveliev. The second photo is called Weight Lifting: Black and White by imagesbywestfall. Both are sourced from Wikimedia Commons.

23 thoughts on “Three Words Therapists Do Not Speak: Strength of Will

  1. Dr. S, this was the boost I needed. June is trigger-city for the PTSD, making every day arduous, but you made me proud of myself I’ve held onto therapy for 4 years and make the effort — both literally and figuratively — to show up and do the work in my appointments. Thank you for the wonderful essay. 🙂

    Liked by 1 person

    • drgeraldstein

      You are welcome, Harry. You have much of which to be proud. And you made me happy to be of some help to a kindred spirit!

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  2. I like that you have the photos of those who have literally got strong through physically painful exercise, its the same mentally and emotionally. To get strong you have to ‘choose pain’ to get the results you want, there is really no other way. When you look at the flip side and see how detrimental avoiding pain has led to an obesity epidemic with major health repercussions. My own journey has been unbelievably painful and ongoing for a couple of decades now and I know there is more pain ahead, but I’ve gained a measure of life and belief in my own future that I never would have dreamt possible when I started. Thanks for the affirmation Gerald its nice to know that a clients strength has an impact on the therapist as well.

    Liked by 1 person

    • drgeraldstein

      You are welcome, Claire. You’ve made the case very well. Indeed, we must “choose” some of the things that are forced upon us in order to make the best of them. Pain is going to come our way no matter what. There is no life without it. The question then becomes how to maximize the value of the pain and minimize unnecessary pain. Courage, in effect, makes use of pain for something worthwhile.

      Liked by 1 person

  3. I loved your post Dr S, just what I needed to hear at this stage in my therapy

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  4. I learned from reading your wonderful post, that my game isn’t over, just taking a very lonely, but needed break. That feels better, knowing that. I just need to find a way back when I’m ready and stronger.
    By the way… This is your best one yet.
    J

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    • drgeraldstein

      Good for you, Jill. And thank you for the praise. I shall think of you if I ever decide to get a publicist! 😉

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  5. This was very helpful. Just beginning to look at some rather painful repressed memories in therapy. It was somehow very uplifting as if the power is mine! After a very long spell in the dark there is possibly a light at the end of the tunnel. I can do this! Thank you.

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  6. Another well written and powerful post, Dr. Stein. Thank you for what you do.

    “Strength of will”: it’s our best armor to move forward and upward out of the valley of darkness.

    By the way, you should consider writing a book on therapeutic healing. Your sense of humor is appealing and you have a mastery with words. “Intestinal fortitude.” Why didn’t I ever think of that?

    Liked by 1 person

  7. Thank you so much for another excellent post! This is a difficult one for me, and I really really need to think about this further. In many ways it ties in perfectly with a big part of what I’ve been thinking about over the last few days. I talked with my therapist last week about her own experience of therapy (over the course of a five year period) and it triggered off my ‘usual’ feelings of failure about whether I am ‘doing therapy right’ and whether I am making any progress. I also finished reading Yalom’s latest book, ‘Creatures of a Day’, and although, as with two of his others that I’ve read, I absolutely loved it, it had a similar effect. Once again I plunged into worries about whether I was managing to go beyond surface or achieve intimacy; I feel I struggle to keep topics going and delve deeper, I don’t know how and when to return to a topic, I still feel so trapped by feelings (e.g. worries over contacting my therapist to often and somehow driving her away) that have been there for ages and I still can’t seem to shake, despite apparent ‘realisations’ about her caring or her acceptance. However many times my therapist tells me that there is no ‘right way’ of doing therapy, or reassures me it’s fine to contact her, or whatever else it might be – I simply cannot shake the inner structures/worldview that propagates and maintains these beliefs?
    So is it down to a lack of will? Certainly, I have always thought of myself as someone with little or no willpower. To use a trivial example, it certainly applies to chocolate and food in general! But I pushed through academic and work hurdles, presumably with a fair amount of willpower, particularly considering my mental state during some of it. I pushed through six years of panic disorder without admitting it to anyone until nearer the end – not a good thing and not something to be proud of, really, but still possibly a twisted demonstration of ‘willpower’ of sorts.
    But I’m still not brave enough to say certain things in therapy; to talk about how I’m feeling in the moment rather than at the next session, and I’m starting to realise both the fact that I managed as a teenager and in my early twenties to unconsciously use strategies that helped me in my depression; but I am not using those now, and part of it is, sadly, deliberate. I prayed/meditated; I read and wrote poetry; I made a list of helpful/inspirational passages from books I read; I composed music etc. It’s true to say I have very very little time for these things anymore, but undoubtedly part of me is terrified at trying them, in case they work. I’m scared of invalidating myself, of losing the only identity I feel I have. I am scared of somehow undermining the process of therapy – I don’t want to stick a plaster over the problems anymore, I want to get at the root cause. But at the same time I am so attached to the process of therapy and my therapist, that I don’t want the process or that attachment to end – and whether for this reason, or my ingrained patterns of negative thinking, or other reasons, every ‘success’ and bit of progress is followed by what feels like a backlash against it.
    Do I lack will to get better? I certainly did when I first started psychotherapy two years ago. I told my therapist in the first couple of sessions that I felt guilty having therapy because I didn’t have the right to be there because I couldn’t say hand on heart that I wanted to get better. I was far too scared of the prospect of recovery and change. She was wonderful and told me that that was fine – I was where I was, and that wasn’t a problem and it certainly didn’t exclude me from therapy. Her position really helped, and I would say that I have definitely moved from that position a little and on the whole I _can_ say I want to get better, and much of that is to do with my children – but do I have _sufficient_ will for that to happen? I don’t know……I think part of what’s holding me back are all those ‘pictures’ some of them probably inaccurate, of what therapy is supposed to be and do, and how it is meant to be experienced, and again my reading partly added to that. Perhaps I place too much emphasis on emotional experiences – on tears and ‘revelations’. Perhaps when I feel I’m not able to ‘go deeper’ it’s simply that I haven’t found the words or formulation that will ‘click’ and alter my worldview or change my understanding in a way that makes a felt impact, right at my core. I feel that I need to understand how the process is meant to work – but even Yalom at 82 says that _how_ healing happens is a bit of a mystery. Is it trust that I lack then, rather than willpower? Trust in the process, and in my own and my therapist’s ability to navigate it?
    I think I need to think about this more…..but as you can see your post was ‘perfectly timed’ as it were and thank you for giving me the space here (apologies for the long comment!) to think ‘out loud’……!

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    • drgeraldstein

      First, nothing I’ve read of your writing and your history suggests the presence of a lack of will. On the contrary. The standard you hold for yourself is high and I’d venture to say that the “arm weariness” and “psychological weight” of the standard up above your head might be of as much importance as whatever “root causes” are down below; just a conjecture. As far as fearing that getting well would mean the end of your therapeutic relationship, while that is true, I have a different spin on it. It seems you are imagining yourself as you are today having to end that relationship at some future time, still feeling as you do. In fact, however, if you continue to progress you will reach a point at which ending therapy will feel right and be your choice. Take care.

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      • Thank you so much – I very much appreciate your reply and your insights. As I mentioned to you in a comment thread on my own blog, your are absolutely spot on in terms of the second half of your comment and you completely echo what my own therapist says to me. I think you’re also spot on in the first half too – the drive to get things right, to follow the rules, to do well, to please – these are all great problems that sometimes feel completely ingrained and insurmountable. I cannot seem to escape their clutches, however hard I try, but I know that I need to, before I can be happier. And I’m gladdened and humbled by your view that I am not demonstrating lack of will – however many times you may have mentioned we must not place too much store on others’ opinions of us (!), I hope you will understand why this comment is important to me, at this point in time and I am very glad you made it. Thank you for your good wishes and, once again, for your immensely thought-provoking post…

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  8. On a completely separate matter……apologies for mentioning an unrelated matter in this thread, but I wasn’t sure where else to raise it…..following on a little from the recent posts on friendships with one’s therapist, and the various boundary issues involved, I was wondering if you have written about physical touch in the context of psychotherapy? I know that there are various branches of psychotherapy where this is an integral part of the healing work, but I am referring more to ‘traditional’ (for want of a better word, which may not even be accurate!) psychotherapy. My therapist has made it very clear, for example, that hugs are outside the boundaries of therapy. It was a shock to hear it so plainly – I think I had still harboured hopes of receiving a hug ‘eventually’, perhaps in our last ever session. But I still really struggle with this, particularly when I feel more ‘childlike’ and am desperate for some physical contact or to be held. I understand her point, when she says that although the child may want a hug, it is much more complex for the adult. Part of me resits this – why can the adult not just want a hug too? – but at the same time I know that my feelings towards her are complex, and of varying different sorts, and I know that’s what she means. At the same time, learning to deal with the ‘greyness’ and richness of relationships, seems to be part of the work in therapy, and part of me would so like to apply to that to the concept of touch in therapy. Particularly when ‘encouraged’ by examples like Yalom, who wrote that he liked to touch his clients at least once during session, even if this was simply a hand on a shoulder or shaking hands at the end of session. So often I feel that those who touch me want something from me- but this is not something my therapist can ‘help to rectify’ if we are not allowed physical contact….anyway, as I had been thinking about it a lot recently, I wondered what your thoughts were and if you had already shared insights in a past post…..

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    • drgeraldstein

      I don’t recall saying very much about it. You are right, the traditional model is “hands off.” I know some therapists who fudge a little bit on this, at least with a few patients. There is lots of complexity here, as you’ve suggested in your post. That is about all I have to say about the subject, I’m afraid.

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