How Therapy Makes You Stronger
Topics covered in this article include:
- Building mental toughness with a therapist’s guidance
- How anxiety and depression feed each other
- Escaping avoidance
- Toward lasting change
People often seek therapy when they feel overwhelmed, out of control, or unable to take positive action. They think they come to figure things out and may not know that psychotherapy can make you stronger. Making decisions and following through isn’t simple willpower. How does this work?
Life confronts us with unexpected challenges, like a global recession that drives good companies out of business. This becomes your problem when you discover that your employer of 20 years is shutting down next week. Your world has just turned upside down. You don’t know what to do. You catch your breath and find yourself with scary choices. Do you abandon your career? Take any job you can find? Go back to school for more training? Move to a smaller home?
You (and many others) might find it difficult to pick up the phone to get things going and put yourself down for being “weak” or “lazy.” You can’t muster the “get up and go” to get it done. Maybe you force yourself to act. Even then, why was it so hard? Are you really lazy? And how do you overcome that?
“When the going gets tough, the tough get going.” 1
Our cultural ideal is to be strong in adversity. It’s an ideal because it’s not something everyone can do. It’s also far too easy to see toughness under pressure as an ability you either have or not. But our living world has few absolutes. Most handle some situations well and get overwhelmed by others. Can you strengthen your ability to keep your wits under pressure? Absolutely! Let’s see how you can build mental muscle 2 to be tough in adversity.
Think of a decathlete in the Olympic Games who competes in 10 events that test strength, skill and endurance over a grueling two days. A decathlete’s training cannot neglect any of these attributes and needs time to succeed. Otherwise, they’ll excel at the shot put but fail at the javelin throw or 1500 meter run. Likewise, if you’re going to build mental muscle, you’ll build on your strengths and shore up weaknesses.
A person with mental toughness 3 faces challenges directly and is effective in solving them. I believe that someone who’s mentally tough has a combination of willpower, skill and resilience. How does therapy help you develop these attributes? Let’s look at the elements of mental toughness, and how these are addressed in psychotherapy. An experienced therapist will consider your specific needs and apply proven approaches to help you. Growth usually doesn’t occur in a simple, straight path but unfolds through a process of trail and error over time. Therapy can help you pace and track this process. It’s the therapist’s job to explain a treatment plan that specifies goals, methods, time and costs.
Building Mental Toughness With a Therapist’s Guidance
Willpower can be thought of as a combination of intention, effort and courage.
- Intention is the “will” in willpower. It’s the tenacity to stay on task or return to it until the work is done. To build awareness of what may need to happen, your therapist may help you clarify your values to make choices consistent with them. You may also explore the consequences of changing a behavior – what you may fear losing as well as what you may gain, so when you’re ready, you’ll choose to change on your own terms.
- Effort is power and is enhanced by helping you accurately gauge the amount that’s needed. If you’re facing a big challenge, you may be scared or feel helpless or hopeless about taking it on. If this is the case, your therapist will address your vulnerability to anxiety or depression, so you don’t stall out. If you give up easily, you may surface the thoughts or past experiences that leave you feeling scared, helpless and hopeless and then explore alternative ways to view the situation. All along, you’ll be buoyed by the therapist’s encouragement and support.
- Courage is the willingness to bear the intensity of fear and other emotions and do what you need to anyway. An essential element of courage is awareness. Newer cognitive therapies 4 train people in mindfulness to build their capacity to witness their experience and act in their best interest despite discomforts and distractions. Behavioral therapists also train clients to deepen their ability to relax and access that relaxation at otherwise tense moments, helping them be “cool under fire.” Psychodynamic 5 and other therapists encourage you to disclose your experience without censorship. They join with you to explore the difficult emotions and thoughts that surface, sometimes tracing their origins to past experiences, which can help you release their hold on you. Methods that address the intensity of emotional discomfort, such as EMDR (Eye Movement Desensitization Reprocessing) and imaginal exposure have you review traumatic experiences in the safety of the consulting room and help free you from the fight, flight or panic responses that often accompany such memories.
At the depths of the Great Depression of the 1930s, Franklin Delano Roosevelt stood at the inaugural podium on withered legs supported by steel braces and proclaimed that “the only thing we have to fear is fear itself.” How can you develop this kind of courage? Through facing your fear and doing what you need to anyway, you progressively conquer that fear.
For example, if you’re afraid to drive over bridges, you may avoid any route that involves a bridge. Your therapist may teach you slow, deep belly breathing to relax or show you how to tense your muscles and let them go to induce relaxation. He may also introduce you to exposure therapy, where you practice relaxation breathing while viewing the bridge from afar. You may then go near an actual bridge while practicing relaxation until you calm yourself enough that you’re able to drive over the bridge. You may begin the exposure process by imagining the situation at a distance, then closer, which readies you for encountering the actual situation.
I like to think of skill as a combination of awareness, thinking and perspective.
- Awareness is attention and focus. These are developed through exploring the issues that cause difficulty and becoming aware of what may contribute to them. Where life stress triggers strong emotions, you may be trained in meditation, where you build your ability to concentrate or mindfully conduct everyday activities rather than fumble your way through them. Other tools that build awareness are journal writing; diary cards; focusing on your feelings until you have a deeper intuition about what they’re reflecting; and dreamwork, where your associations may provide insight into your attitude and life situation. Sometimes attention and focus are impaired by brain dysfunctions that feel disabling, such as severe depression, Bipolar Disorder or Attention Deficit Hyperactivity Disorder (ADHD). For these conditions medication can be especially helpful. Awareness may also be impaired by substance abuse that needs to be brought under control.
- Thinking. Cognitive therapists help you train awareness and thinking through the use of automatic thought records. <>6 Here’s how those work. Some situation throws you off balance. As soon as you can, you write down what happened and examine the thoughts that were triggered by the situation and whether those thoughts are a distorted description of what you observed. Then you write down the feelings that were elicited by those thoughts and gauge their strength. Next, you dialog with those thoughts to find a more adaptive response. You conclude by measuring the intensity of emotions that now relate to that incident. Often you’ll find that your emotional response has calmed considerably so you’ll have a more adaptive response going forward. You can receive similar benefits by examining such situations, thoughts, emotions and possible responses with your therapist. She may also engage you in role play to build confidence and teach you new skills. These methods all help you think more clearly under pressure. Some people may have learning and attention problems that are innate, such as dyslexia. Your therapist may refer you for assessment and address such issues in your treatment plan.
- Perspective is the ability to take a step back from the immediate situation and view it in context. A solution-focused therapist may help you imagine the life you want and start doing the things that build such a life. Imaginal approaches such as dreamwork, art therapy or sand tray therapy encourage you to work with images you spontaneously produce. These methods and others like them help you see that your unconscious mind already has the broader perspective you’re seeking. Talk therapy is the method most often used to help you gain perspective. Your therapist may guide you to explore your situation and the many influences that create it. Sometimes, interpreting your actions through the lens of unresolved childhood conflicts can help you understand responses that no longer make sense. You may also benefit from assigned reading and discussion of research findings about your particular situation.
Resilience is needed for staying power, and can be seen as a combination of patience, flexibility, self-care and support.
- Patience can help you avoid compounding problems and make it possible to time your responses more effectively. It’s taught through encouraging realistic goals. If you try meditation practice, this builds the ability to remain focused despite distractions or discomfort and helps you hold your focus for a longer time. People who are so impatient they often take ill-considered, impulsive actions may need to learn emotion regulation and distress tolerance skills or stop feeding addictions. Impulsive actions can also be triggered by anger. Those prone to anger can benefit from anger management classes and training to assert themselves more appropriately, considering others’ needs as well as their own.
- Flexibility is the willingness to change your action plan as circumstances evolve. It begins with developing insight about your situation, including exploring alternative courses of action. Several therapeutic processes support flexibility, including dialog, role play, problem-solving and communication skills training.
- Self-care is essential when people are under stress because the mind has a body! Good physical health gives you the stamina to withstand stress. Often people find that depression starts to lift by beginning regular exercise, eating healthier meals, and learning proven methods to deal with insomnia (or seek medical help if insomnia continues). People may also stay in situations or relationships that are so stressful they need to resolve them or move on. A good therapist will help you do this. One of the most important elements of self-care is having compassion for yourself, because few people choose to be stuck. They’re usually doing the best they can with the knowledge and means at hand. Your therapist will help you survey your self-care practices and help you identify medical problems whose symptoms may masquerade as mental illness. Licensed therapists are trained to pick up on that possibility and refer you for a medical work-up. As with building other strengths, self-care must include resolving addictions that prevent full healing.
- Support is something we all need because we are stronger collectively than alone. Building a support network may involve helping you plan and access the most helpful members of your family and community and includes your therapist and others in your treatment team. Some people benefit from support groups or group therapy. Also, your therapist may recommend more frequent sessions if you’re under great stress or if your discovery process becomes so active that you could use more time for processing your changes.
Toward Lasting Change
You’ve now reviewed the characteristics that make up mental toughness. You’ve also seen how your therapist can help you do the challenging work that builds individual strengths. One of the payoffs of a successful course of therapy is building a more positive attitude and optimism that you can overcome even difficult challenges. Increased mental toughness is a gift that will keep on giving for the rest of your life. In closing, I recall a simple tale from childhood that can serve as a metaphor for how mental toughness can help you overcome great adversity. The Little Engine that Could 8 is an illustrated children’s book that retells the story of a locomotive that accomplishes a seemingly impossible task. Here’s an early version of that story:
A little railroad engine was employed about a station yard for such work as it was built for, pulling a few cars on and off the switches. One morning it was waiting for the next call when a long train of freight-cars asked a large engine in the roundhouse to take it over the hill. “I can’t; that is too much a pull for me,” said the great engine built for hard work. Then the train asked another engine, and another, only to hear excuses and be refused. In desperation, the train asked the little switch engine to draw it up the grade and down on the other side. “I think I can,” puffed the little locomotive, and put itself in front of the great heavy train. As it went on the little engine kept bravely puffing faster and faster, “I think I can, I think I can, I think I can.”
As it neared the top of the grade, which had so discouraged the larger engines, it went more slowly. However, it still kept saying, “I–think–I–can, I–think–I–can.” It reached the top by drawing on bravery and then went on down the grade, congratulating itself by saying, “I thought I could, I thought I could.” 9
To schedule a first appointment please select this link. Although experienced with emergencies, that is not my practice focus. I work with people who can reliably cope, are not at risk or in crisis, do not have thoughts of self-harm, and are seeking to grow.
1. This is the title of a song performed by Billy Ocean in 1985 and featured in the film, “The Jewel of the Nile.” The song was authored by Wayne Braithwaite, Barry Eastmond, Robert John “Mutt” Lange and Billy Ocean.
2. “Building mental muscle” is a favorite phrase of Allen Bishop, Ph.D., a psychoanalyst and former chair of the clinical psychology program at Pacifica Graduate Institute.
3. My understanding of strength of character is influenced by psychoanalyst Heinz Hartmann’s nuanced description of the components of “ego strength.” See “Comments on the psychoanalytic theory of the ego.” Freud, Anna (Ed); Hartmann, Heinz (Ed); Kris, Ernst (Ed). (1949). The psychoanalytic study of the child. Vol. 3/4. Pp. 74-96. Oxford, England: International Universities Press.
4. Here, I’m referring to Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, Ph.D., and Acceptance and Commitment Therapy (ACT), developed by Steven Hayes, Ph.D.
5. Psychodynamic psychotherapy employs insights about the effects on personality of early childhood relationships to one’s primary caregivers. For example, the ways a person handles conflict was first established in these early relationships, before a person has critical thinking ability. These behavior styles show up later in the dynamics of human relations later in life. Understanding the origins of coping skills that are no longer adequate can help defuse shame. The point is not to blame your parents but to help you accept yourself and make new choices.
6. Beck, A., Rush, A. J., Shaw, B. F., Emery, G. Cognitive therapy of depression. (1979) New York, NY: The Guilford Press.
7. My understanding of this idea comes from Kleinian psychoanalysis, where it is known as a “narcissistic haven.” Dr. Avedis Panajian. Psychoanalytic Psychotherapy II. Classroom presentation at Pacifica Graduate Institute, Carpinteria, California. April 27, 1997.
8. Piper, W., Hauman, G., Hauman, D. (1990). The little engine that could. New York: Platt & Munk Publishers, an imprint of Grosset and Dunlap, a division of Penguin Young Reader’s Group. Originally published 1930.
9. “The little engine that could.” Wikipedia, the Online Encyclopedia. Downloaded 5/3/09 from http://en.wikipedia.org/wiki/The_Little_Engine_That_Could”>http://en.wikipedia.org/wiki/The_Little_Engine_That_Could