In reality, it is hard to imagine a more pragmatic and worthy task. With a clear sense of yourself, it becomes easier and easier to grasp why you feel the things you feel, and why you react to your emotions the way you do. Your behaviors and the decisions you have made in your life begin to emerge in comprehensible patterns. And once you can identify the patterns, and the emotions and actions that bring them about, you can begin to steer your life toward those patterns that give you fulfillment and away from those that are stagnant or even harmful.

Which is not to say that therapy isn't work, or that it doesn't require looking at yourself with unflinching honesty, because it is, and it does. And although the therapist is there to guide you, he or she cannot do the work for you. One of my mentors in psychiatric training once told me, "You should never work harder than the patient." Not because a therapist isn't willing to dive with you fully into the struggle but because, in the end, the struggle belongs to the one who must live it.

So, when therapy is working properly, there is not a smidge of self-indulgence around. It is sometimes uncomfortable—we are, for the most part, unaccustomed to scrutinizing our deepest selves, let alone sharing the view. And that type of truthful assessment can be scary. Often, when a problem seems thorny enough to merit therapy, the feeling is a bit like being stuck in a foxhole in the middle of a war: The situation becomes more and more miserable, but the thought of leaving it is utterly terrifying. (This may help explain why, according to psychologist and marriage expert John Gottman, PhD, couples are unhappy with their relationships for an average of six years before they seek help.)

Therapy can also be draining—some patients cry the whole session, every session. Others find it exhausting to constantly be asked to identify and articulate their feelings about the situations they describe. But as is true with many things in life, from triathlons to flawless presentations to raising children, great effort can translate into great reward. There is a kind of exhilaration that comes with each new moment of self-knowledge, and an enormous sense of relief and joy when the most impenetrable problems begin to crack open.

From a scientific standpoint, there is researched evidence that therapy is effective; that it can decrease physical pain, nausea, and fatigue; that it improves quality of life for people with cancer; that it actually restructures the pathways of neurons in the brain so that cognitive and behavioral patterns that have been deeply entrenched for years are rerouted.

And then there is evidence of the less scientific kind: a friend whose panic attacks stopped when her therapist taught her relaxation techniques; a family on the verge of rupture who learned in counseling how to be happily and deeply involved in one another's lives; an acquaintance who tells me she did not know who she was until she gave herself the gift of therapy to find out.


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