One of the therapist’s first tasks is to gauge the new patient’s discomfort. If he is drowning, the doctor’s job is like that of a lifeguard, to secure and elevate him straight away. But if he is treading water, head still well above the chance of a big gulp, the inexperienced counselor’s mistake must be bypassed: taking or allowing the sufferer into the swirling downspout of his emotional whirlpool.
Entrance there leads to a subterranean dark place on a high-speed descent. His well-being and stomach for counseling might be left behind.
The depth of psychic trouble will often — and often must — wait. Trust in the relationship and safety come first. Only when some grounding work is done can you best search for a place I’d call “a useful level of discomfort.”*
Useful how? The patient, assuming the distress is not entirely new, waited for some time to come to a professional. The woman or man lived a complicated life, tried self-help books or will power or faith or work or drugs or sex or each of these to better himself. Arrival at the clinic means nothing worked or worked enough.
He needs to move past his sticking point, the concerns he didn’t want to think about, open up about. If he becomes overwhelmed, however — by too much, too soon — a premature end to the office visits is likely. Stopping short of the mucky floor of his emotions is necessary. There is a zone of useful discomfort in a less acute, sustainable place higher up.
The in-session professional senses this, watches for it. Imagine the consulting room divided in half. On one side of an invisible partition sits the counselor. On the other, his client resides in a breathable, transparent fluid. Much movement occurs within the liquid, high and low, serene or agitated or depressed: the entire range of possibilities to which our hearts are subject.
The individual requires acute attention. Where he exists within his emotional space might change a dozen times before the clock suspends his share of the therapist’s face-to-face focus; in the same place or another, up or downriver.
Here is one of the reasons the doctor monitors the elapsing passage of the hour. He must, if he can, retrieve the drifting, disconsolate patient before session’s close; get him to shore. Leaving him with “useful discomfort” is often acceptable. A client who is worse off with regularity as he leaves the building is a guarantee of treatment failure. Health care professionals don’t want those in their care suffering the engagement too much.
The time is and is not the patient’s, though he purchased the visit. He owns that it happens, but the provider’s job is to manage the way it happens. Think of the latter as a traffic cop of sorts, the conductor of the flow of ideas and moods. The doctor reinforces the guard rails, keeping his charge from careening off the tracks, the chasms in his psyche through which he will fall if the session ends in the wrong place.
Those in psychotherapy possess many escape hatches. Full frontal immersion in a place they have avoided will force them to rely upon these old survival techniques and defenses. Only these, not their healer, then signal possible relief. The patient will have returned to the place of his former misery, but be glad because the prescribed ministrations, interpretations, and nudges made him worse.
The lesson of useful discomfort takes you forward, not retreating from life. Much of our flourishing depends on finding a way to tolerate unpleasant situations, not flee them. Resilience and courage incubate here. With experience, the formerly uncomfortable territory becomes less noxious. The circle of life enlarges.
The therapist should not be like a sadist slow-cooking you on a spit. His desire for your useful discomfort is to sustain your capacity for facing your issues without making the offered remedy either a feel-good waste of time or an intolerable ordeal guaranteeing a defeat of the therapeutic project. In effect, he is saying, like Dorothy in The Wizard of Oz, ‘”you are not in Kansas anymore,’ but this is the necessary place for you now. I will do my best to make it manageable.”
Like Dorothy’s “yellow brick road” Odyssey, the effort leads to discovery of the strength inside you. From there, whether home or away, new adventures are possible. You are now the master of your self.
The second image is Ancient Harmony by Paul Klee. *The expression “useful discomfort” is borrowed from a recent article about climate science/