Psychotherapy is an odd profession in some ways. There’s a lot of science behind what we do, but there’s also art, creativity, and imagination. The science teaches us about how people respond to trauma, how we encode memory, or how emotions correspond to chemical changes in our brain and endocrine system, among many other things. It’s truly amazing to consider what we have learned in the last century and how much more equipped we are to help people.
As for the art, well, we don’t like to talk about that much. Survey psychologist websites (even our own) and you’re more likely to find boasts of “evidence based treatment” and “data driven approaches” than those of relationship-building, connection, or creativity. Clinical professionals emphasize a lot about how much we know, but emotional healing is so complex that it defies comprehension. And that, if you’ll forgive me for being meta, is something that we do, in fact, know. So why don’t we act like it?
Let us consider, as a corollary, the discovery of genetics - arguably one of the most important milestones in scientific history - which catapulted our understanding of evolution to new heights. This discovery revealed the apparent digital nature of our genetic code. How exciting it must have been to realize that our genetic blueprints could be known and even read! But, of course, there was much more to learn.
Several decades later, an understanding of epigenetics revealed that there is far more going on, that genes are “expressed,” that they can be turned on and off by external factors like stress, temperature, or nutrition. Some have likened this to the dynamic interplay between a pianist and keyboard. While the keyboard provides a series of 88 discrete pitches, the pianist performs an interpretation of the score with varying degrees of insight, skill, and musical maturity. Classical music enthusiasts love to debate which among Glenn Gould’s recordings of the Bach Goldberg Variations is superior - the vibrant 1955 recording or the pensive 1981 recording - and their disagreement illustrates the infinitude of musical possibility.
My point is that while the genetic code may be digital, gene expression is analog; it is continuous in the mathematical sense, fluid, and imprecise. That is the poetry of our genetic reality. Fully knowing the dance between genes and environment would be like dropping a boulder into the ocean and predicting the trajectory of every disturbed molecule and sub-particle. What epigenetics tells us is that we are far more complex than the digital sequence of our genes would suggest, and this level of complexity exists in every sector of physical and social science. Each new discovery reveals a pebble of truth and a mountain of questions.
In our profession of clinical psychology, there’s an unfortunate tendency toward scientific posturing. We spend a lot of energy demonstrating that our methods are evidence based; a lot of hot air is expelled in references to studies and research and data and facts. We love to say things like, “this is the region in your brain that controls the whatever function, and increased cortisol levels may cause the what’s-it-called reaction, and this latest [acronym] treatment has been shown to outperform [other acronym] treatment, and you really should be working with a psychologist certified in neuroreductive smartypanteological therapeutic stimulation.”
The truth is that we do know lots of things - really cool things! - but that’s not necessarily what makes us good at what we do. Mental health professionals are under constant pressure to demonstrate our worth, and society’s best metric for that is the appearance of scientific rigor. It’s only natural that we would stand proudly behind the science and shy away from the art, all that squishy stuff everyone is so afraid of.
But we are supposed to be the squishy stuff experts! Our professional history is intertwined with that of medicine, and we developed much of our professional knowledge within the boundaries of a medical model. This was great for developing taxonomies, not so great for understanding people in any way that could be considered whole. Today, we therapists find ourselves pulled between two worlds, one that is rediscovering Jungian ideas like archetypes and the collective unconscious and expecting spiritual catharsis, and another that wants prescriptive, evidence-based solutions. Fortunately for all parties involved, most professionals know this is a false dichotomy.
Finding the right therapist for you or your family can be daunting. There is no easy method for comparison, and it’s hard to know what you are looking for. Here is a quick tip. Most therapists will consult with you briefly before getting started, and that is a good time to ask about how therapy works. Don’t be turned off by therapists who wax scientific about their intervention skills. Prompt them about how they approach building a relationship, and then check your feelings about what it might be like to be vulnerable with them. Irrespective of their website content, many therapists truly embrace the science and the art of what they do. If only the broader public could be a fly on the wall when we consult with one another other in trust. That’s where the magic is; that’s where you can find the squishy stuff, where we explore our observations and subjective experiences in balance, and yes, where we recommend evidence-based techniques.
Science really has brought us a long way these last hundred years. We no longer sit on our clients to simulate their birth, so we can all be happy for that! But what really makes the science work is an acceptance that we don’t know everything under the hood, that we can’t calibrate your vagus nerve to help you find inner peace or regulate your serotonin levels with modulations in our tone of voice. We can, however, help. By listening and reflecting, by sharing in your experiences, and by whole-heartedly witnessing you and your feelings, we can help you find a way through. And that, if I may, is pretty damn good.