What Is the End Goal of Therapy?
This is an important question to ask a therapist or to at least reflect on in your own time. Many of us come to therapy with immediate and acute goals—to manage anxiety, to have better focus, to feel less depressed. In many cases, some relief in therapy for these matters can be achieved, and bigger questions open up—what kind of life do I want? Is there some use or insight to my depression? Can anxiety serve me as well as harm me?
These broader musings raise even larger questions about what the ultimate end goal of therapy should be, or when do we know that we are treated or “cured”? Is it when we are never depressed again, or is it when we understand the nature and causes of our depression?
Therapeutic Goals Differ
When we start to ask these larger questions, we enter into a wider realm of differing therapeutic stances and viewpoints of what is even considered cured or “better.” While psychotherapy has a foot in the hard sciences, it differs from medical science in that there is less consensus on what being cured means.
In medicine, healing a broken bone or lowering one’s cholesterol might be an agreed upon treatment goal. Knowing what positive or optimal Mental health looks like varies quite a bit between schools and practitioners. Knowing some of the major theories around treatment and cure can help orient realistic expectations for clients and offer more complex and imaginative treatment goals than simply “feeling better.”
Ordinary Unhappiness
The originator of modern psychology, Sigmund Freud, offers a deceptively simple goal of psychotherapy as moving from “hysterical misery” to ordinary or “common unhappiness.” At first glance this may seem disappointing given our cultural pursuit of happiness. While Freud and most long-term psychotherapies do not offer us a guarantee of happiness, they do offer the hope of a return to “love and work.” In today’s language, we might speak of a return to being “functional.”
This does not mean spending every day in bliss or happiness, but a freedom from the intolerable suffering that many of us endure from time to time. For those who have indeed suffered from intense existential pain where life feels unbearable, returning to a place where one might worry about more banal things, such as managing a diet or deciding on travel plans, might be welcome relief. Freud’s notion also normalizes unhappiness as a feature of living, thus de-pathologizing unhappiness as an illness in need of a cure. Psychotherapy may indeed bring some happiness and foster a more enlivened life, but it may also produce sadness en route to wisdom.
Becoming Fully Adult
For Freud’s counter-part, Jung, the aims of a successful therapy would be to achieve something of a more autonomous and adult life. As Jungian analyst James Hollis puts it, the therapeutic process is about ceasing to be a “creature of fate” and seizing more responsibility and accountability for one’s life. As other Jungians have put it, successful therapy would mean being able to stand in the face of life’s challenges and fates and say “I”—I accept my fate and act according to my conscience.
This notion of cure here is often a lifetime process. There is an existential dimension as one learns in the process of treatment to be more accountable for one’s decisions (as well as the consequences) and to relinquish a sense of blame on family, society, or fate. This process involves a slow weaning of reactive habits developed in early life that may have been effects and products of our family of origin.
The Jungian cure would be to identify these as artificial habits and renew our actions with our adult self (desires, ambitions, failings) in mind. This involves risk and experimentation since our reflexive habits are often easier to sustain even if they come at the cost of a neurosis or a complex. Being an adult here means acting in our lives without fully knowing or being able to predict the result, and assuming and accepting the consequences as our very own.
Accepting the “Depressive” Position
Becoming an adult, or accepting full responsibility for our lives, can often lead to a heaviness experienced as a depression. For Melanie Klein, this “depressive” position would be the fully realized therapeutic cure. While not a promising name for some, the depressive position is a more adult and realistic appreciation of the world and, in particular, people in our lives.
Klein describes early childhood experiences where we often “split” into seeing things—like mom—as either wholly bad or good. If mom satisfies us with food and attention, she is all good and all loving. If mom frustrates our desire by going off to work or attending to another child, she is all bad.
This splitting can very often carry over into adulthood, particularly in our relationships. If anyone has ever cut off a friend or a family member out of anger or a sense of betrayal, we have psychologically “split” into a black and white universe. People who suffer from borderline personality disorder frequently experience this acutely, but all of us experience splitting from time to time, especially around stress and anxiety. A sudden life event like a death, illness, or a loss of job may produce temporarily extreme or one-sided viewpoints on people in our lives or on politicians or employers.
The aims of therapy here would be to reduce and manage splitting, and allow us to see reality as a more nuanced and complex entity composed of variations of good and bad. While easy to conceptualize, this is difficult to realize in reality, since it often involves looking empathetically at people who have hurt us. For example, we may harbor a grudge against a neglectful parent but come to realize that they have their own psychologies and may have been doing their best despite the negative impact we experienced.
Resisting “Normal”
While some treatments aim to steer the client towards a notion of “normal,” others actively resist this treatment direction. For Erich Fromm, and more recently in the work of Gabor Maté, being or becoming “normal” itself is seen as a negatively conformist aim of institutional psychotherapy. While some patients may envision Mental health as being able to participate in routine social life—shopping, amusements, having fun—Fromm and Maté view these “norms” as more problematic and often individually damaging.
They invite patients to critically examine what passes for normal and examine closely the costs of this achievement. They argue that much of what passes for normal can be seen as delusional forms of self-medication from a restless soul. From this angle, those who struggle to be normal, or feel uneasy or left out of the dominant culture may, in fact, be on the better road to wellness. Their aversion to performing in normal rituals may be an appeal to a more authentic and singular life, which may feel “abnormal” by comparison.
In this way, the aims of therapy would be to assess which “normal” activities we aspire to that are mere distractions or self-cures for deeper wants or desires or our general ambivalence with the culture at large. To this end, a cure would enable one to be at home in one’s singular solitude, to be without distraction, and to be touched by both the pleasures and hurts of life without the need to run away, self-medicate, or distract.
Many Versions of the Good Life
Knowing some of the different aims and end goals of psychotherapeutic school and thinkers can be helpful in widening our view of what therapy can do for us. There is not one “cure” or treatment project in psychotherapy, and we must decide for ourselves (as patients) which suits our interests or needs at any given time.
All treatments are versions in some way of what a good life is and how we might get it. Knowing how different schools of thought consider treatment or cure can give us more options in terms of how we see therapy and how we see the end goals. For some, being free of excessive symptoms and finding some normal is a worthy goal. For others, reframing normal as a social production and “normalizing” one’s difference may prove a meaningful endeavour.
