Therapeutic Assumption - No. IV

Hi there!

Welcome back to the MoodiNews. Every Thursday, we discuss a variety of matters related to mental health and self-improvement.

I’m so glad you’re here.

This week, we are going to continue discussing: THERAPEUTIC ASSUMPTIONS! (YAY!)

Last week, I introduced the third of five therapeutic assumptions that I use in my work as a therapist. Today, we will explore therapeutic assumption No. IV:

Psychopathology is never an inherent feature in a person.

This idea is very important.

It essentially states that most people, at their core, have very little that’s truly wrong with them.

Therapeutic assumption No. IV is all about reversing the idea that people are naturally ‘anxious’ or ‘depressed’ or ‘crazy,’ replacing this instead with the realization that most people who seek out therapy are just responding to stress in very predictable ways.

Often, when people come in for therapy, they want to address their symptoms (i.e., a diagnoses of depression, anxiety, etc.)—and understandably so.

However, as soon as people start to over-identify with their diagnosis (for example, “I’m just an anxious person,” “I’m such an ADHD airhead,” “That’s because of my depression…”), they lose a lot of power to change.

A large portion of my work as a therapist is about helping people unlearn false narratives about themselves. For instance, it’s often my job to challenge statements like, “Something is wrong with me—if you really knew what goes on in my head, you would institutionalize me immediately!”

I hear statements like this all the time because it is so common for people to think that they are uniquely bad or broken in some way, and to therefore pathologize themselves without much afterthought.

We know from epigenetic science that people develop in the context of both nature (the inborn, genetic traits or characteristics of a person) and nurture (a person’s surrounding environment).

Therefore, while a particular individual might be genetically predisposed to feeling negative emotion or being an introvert, that does not mean that they are also born with depression (which is often characterized by low mood and isolation).

The therapeutic assumption that people are not inherently pathological is important because it helps us to view mental health in the context of nature PLUS nurture, rather than pinning people’s symptoms on some innate, impermeable trait with no regards to lived experience.

As discussed in previous weeks, therapy is all about teaching people how to manage stress and solve problems.

It’s therefore critical to accurately identify the causes of people’s problems (whether biological, environmental, or behavioral) in order to help people recover—and this can only be done when we refrain from assuming that it’s the person themself who is fundamentally defective.

In therapy, when I have clients who pathologize themselves, the first thing that I teach them is this:
It’s not HOW you’re coping, it’s THAT they’re coping.

When we step back and really assess why people struggle, we can always strip down their diagnoses—whether anxiety, eating disorders, addiction issues, whatever—to the fact that they are simply trying (unsuccessfully) to maintain functioning or manage stress. To that end, psychopathology serves less as an indication of internal corruption than it does an indication of a person’s natural instinct to survive.

Understanding this concept helps us bypass blame and recognize, for instance, that it’s usually stress, not conscious choice, that causes anxiety; it’s usually circumstances, not people themselves, that cause the development of unhelpful, compensatory behaviors...

And, when people can begin to recognize their diagnoses as a self-preserving response to stress (rather than an inborn trait), they are more likely to accept and manage their symptoms in a healthier way.

In summation, the idea that psychopathology is never an inherent feature in a person helps normalize and demystify many common and predictable issues in therapy. Many times, people with mental health issues have very good reason for being as they are (even if they still need to change), and normalizing this reality is one of the most empathetic and healing things that another person can do for them.

We will continue to explore this concept of ‘empathy + accountability’ next week, when we discuss the fifth and final therapeutic assumption:

People are doing the best that they can—and they can do better.