In the beginning there was no psychology or psychiatry, but there was religion with its shamans, medicine men or other leaders and there were people with curiosity about our relationship to the universe. In those days, human problems were seen in a religious or spiritual context with the general belief that those problems were the results of external causes such as spiritual intrusions or godly decisions, and religious leaders were looked upon as the persons who had the ability to cure the problems encountered by humans. Cultures and societies contributed all natural phenomena and events to one or multiple gods and developed religious systems in which they feared those gods and believed that it was their responsibility to appease those gods through sacrifices and obedient behavior in order to be spared of harmful natural events. This kind of thinking and religious behavior continues to exist presently in a significant number of humans.
From the beginning, the curious people constantly sought to find answers to the problems they observed in nature, in the skies and the universe, and in people. They tended to be open to answers outside of their religious systems and sought to verify those answers by repeated observations. This was the early foundation of our sciences, finding answers based in information and data obtained through observation rather than accepting answers established through cultural mythology and religious ideologies. Interestingly, the early scientists were also usually religious leaders of their societies. They began by trying to quantify things they saw, thus creating the beginnings of what eventually became mathematics and engineering and they also began studying the relationship of the sun, moon and stars to our daily lives and various events in nature. This was the start of astronomy and the relationship of knowledge of the skies to religious edifices and practices.
Eventually, the scientific study of the universe, nature, and human behavior, and cultural religious practices, began separating and going in different directions. Religions typically solidified into belief systems with rituals and practices that became repetitive and unchanging and based in traditions and myths while science continued to evolve and change with every new discovery based on repeatable information and observation. With regards to human behavior, religions continued to hold beliefs about the externalized and spiritual nature of mental illnesses and the practices by which to undo or overcome those illnesses, such as prayer, absolution, and exorcism.
As science evolved, new ideas and theories regarding human behavior and mental illness came forth that did not include explanations involving spiritual or external influences. The source of human psychological suffering was being looked for within the individual. In the 1800s, Freud solidified this shift by proposing his theory of human suffering and from that he invented psychoanalysis as the go to method for helping people overcome their mental illnesses. Neo-Freudian’s and other prominent medical and/or scientific individuals of that era developed additional systems of understanding human behavior through psychodynamic theories and treating human problems through psychoanalytic or other cognitive or behavior intervention techniques. From this foundation of human behavior, its understanding and treatment, came the evolving and continuously reshaping development of our current systems of understanding and treating human problems and mental illnesses.
So, has this separation from religious explanations of human behavior and suffering to understanding human behavior through psychodynamic or psychobiological theories and methods helped relieve human suffering any better than religions? Unfortunately, the answer to this question is very complicated and unclear. Human suffering has remained a very significant part of life throughout the existence of humanity and remains that way presently. Many religions offer comfort to their followers by assuring them that God watches over and protects them and offers them some form of eternal bliss after death, thus putting human suffering in our lifetimes into a less important and more manageable position. At the same time, many religions continue to offer their traditional forms of problem reduction through the religious practices of their shamans or leaders. On the other hand, psychiatrist, psychologist and other mental health therapists engage in a variety of nonreligious therapeutic procedures or practices in their attempts to help reduce the problems and pains of their clients. Today, a premium is placed on certain therapeutic procedures identified as “evidence-based” as the go to procedures because of some form of evidence that has indicated that they appear to work. However, neither of the religious or scientific approaches have effectively reduced the mental illnesses and sufferings of many of the people who have sought help from them, although both have shown effectiveness in helping people.
So, what works in helping people reduce their suffering and resolve their mental illnesses? In my lifelong studies and observations of human behavior and its treatment, I have found that the following conditions appear to be universally involved when people effectively help each other.
1. Human bonding, including belief and trust in the helper or practitioner.
In the religious domain, it has been shown repeatedly that religious leaders effect “miracle” cures of parishioners who believe in their power to cure. This has been done by Christian ministers, shamans and medicine men of various religions, and ailments and death have been equally imposed on believers by voodoo mystics. In the medical domain, powerful and lasting improvements in people’s suffering and/or mental illnesses have come through strong therapeutic relationships between client and therapist in which the client has developed a trust and belief in the therapist’s ability to help. Almost always, the therapeutic method, if it is grounded in sound psychological principles, is made most effective when applied within the strong therapeutic relationship.
2. Acceptance and respect of others as equal human beings by the practitioner.
People respond most openly to others who treat them respectfully and as equals. They are able to express their fears or aberrant thoughts without the extreme fears of reprisal, criticism or ridicule. They are not inhibited by a sense of inferiority in the presence of someone with higher status. They listen to and accept information or guidance much more easily when not defensive or self-protective. These conditions are true in person-to-person relationships regardless of who the other individual is. That is, one’s religious leader can create this kind of openness as well as a medical or mental health practitioner, a close friend, or a trusted family member. Once this openness is established, the effectiveness of the helper lies in their understanding of human behavior and suffering, including mental illness, and in their knowledge and wisdom of how to apply those understandings while helping the other person. Obviously, it makes sense to assume that the well-educated and experienced mental health practitioner would be most advantaged in helping troubled persons. However, there is a plethora of examples of people being significantly helped by religious leaders and various other persons who have also been able to establish open and non-defensive relationships with troubled persons.
3. Genuineness and congruence between thought, feelings and actions in the practitioner’s interpersonal style.
All people have the capacity to sense when someone is being their real, genuine self rather than “phony”, and they let their guard down in the presence of the genuine person but put up their defenses when sensing dishonesty or “hidden agendas” in another person. People also have the capacity to sense when someone is not interested in them, has some biases towards them or wants to get away from them, and their defenses go up even higher when the person denies any of those impulses and comes off looking incongruent between their true feelings and thoughts and their comments. Dishonesty and incongruence in interpersonal relationships always create some level of discomfort and reduces the potential bonding and effectiveness of interactions between two people. This is true regardless of who the other person is, and it is particularly true with medical and mental health practitioners whose goal it is to help the suffering and/or mentally ill person. When the practitioner is not genuine and congruent in their relationship with their patient, it does not matter what medication therapies are offered or therapeutic processes are employed, the outcome will be at very high risk of failure.
4. Communication honesty in the practitioner.
People cannot change without receiving very clear and poignant feedback on their problematic thoughts or behaviors. This requires having an ability to tell someone else something that may make them feel badly or that may challenge their beliefs in such a way that it is done respectfully and with care. Under such conditions, most people are able to receive the whole range of feedback from constructive criticism to positive compliments. In many social settings, saying anything that might hurt another person’s feelings is considered mean and even wrong, and, so, many people tend to avoid giving the feedback that they would honestly like to give but believe they should not. While this happens regularly in social settings and people go on behaving in annoying or self-defeating ways because of not having their attention drawn to their inappropriate behaviors, it would almost completely invalidate the effectiveness of any therapeutic process if a mental health practitioner were equally dishonest with an individual who manifests inappropriate behaviors.
The difference between getting help from friends or family members and effective therapists is that friends and family members typically take the side of the individual and thereby give them slanted or biased support when critical feedback may have been the most important information for that individual, and effective therapists give critical feedback in order to help their clients with the problems that they encounter rather than taking sides with them and trying to provide support or make them feel better. But effective therapists are able to do this in a respectful and supportive manner.
5. Pursue the sources of the pain(s) causing the client to seek help.
In prehistoric and biblical times, and in the Enlightenment and Renaissance eras of history, the only persons who were available to help people with their suffering and mental illnesses, regardless of how those problems were perceived and described, were the social or religious wise men and leaders. They were usually few and far between because they were exceptional individuals. This was also true in Freud’s era, when only prominent university professors and doctors engaged in the treatment of others, and it remained the same into the early years of the 1900s.
However, in more recent times helping professions have flourished in all kinds of mental health disciplines and more and more people have been able to enter the helping fields with less education, training and experience. Presently, MD’s and PhD’s are no longer the only qualified providers of mental health services, and for that matter, medical services. We now have people with MA’s and even BA’s in mental health and human service positions that can significantly impact the lives of others. It has been my observation that many individuals who have entered the helping fields are marginally trained and have superficial understandings of human behavior and the principles and conditions for effecting human change. Their treatment styles are superficial and ineffective regardless of the therapeutic modalities they attempt to use, including evidence-based systems.
Effective therapy requires that the therapist keeps pushing the client to look deeper and deeper into their thoughts, memories and feelings to discover the origins of their inappropriate fears or anxieties, depressive reactions or impulsive or angry behaviors, or their anguished or worried obsessions. Usually, the client does not readily attempt to dig down into the depths of their problems on their own because of their fears of uncovering pains or discovering horrendous problems. Until the client understands why they have the perceptions or behaviors that contribute to their life’s problems they will have difficulty in solving or fixing those problems.
For instance, to believe that effective therapy for a client who has anxiety difficulties is to teach them such techniques as controlling their breathing, muscular relaxation and meditative techniques, or some sort of thought blocking or thought changing techniques, without identifying the basis of their manifested anxiety, is at best superficial therapy and inevitably destined to be ineffective in solving that person’s problem. This individual’s anxiety may be the direct result of deeply buried memories and emotional scars resulting from childhood sexual abuse or school and/or neighborhood bullying that was never effectively addressed. If that is not identified and treated, the superficial technique therapy cannot help significantly.
Similarly, when a therapist makes one’s week to week problems or difficulties the primary focus of treatment, the underlying causal issues will remain untouched and the individual will not be able to overcome their basic problem.
Now, having criticized a significant number of mental health practitioners for not being adequately educated in and knowledgeable of human dynamics and behavior and its treatment, I have to point out that there are many members of these “undertrained” mental health disciplines who are, indeed, quite effective in helping clients improve their lives. This is true because these effective practitioners usually possess the qualities described above in five essential conditions for effective therapy. That is, they have the ability to bond and establish respectful and honest relationships with their clients that provide the condition for clients to be able to make changes with their support. They also keep an ongoing openness to new information and learning. At the same time, I have to say that I have seen a number of MD’s and PhD’s who do not possess qualities cited above and, despite their comprehensive knowledge and understanding of human behavior, they are ineffective in helping their clients to make positive changes.