No pain, no gain?

Does “No pain no gain” also apply to therapy/ counselling?

Does it need to become worse before it can become better?

During the Covid-19 pandemic many therapists needed to move their practices online. Consequently, new procedures and protocol needed to be put in place. Most importantly, to regulate this type of therapy.

To communicate these procedures and protocol to clients, various templates were shared during this time. I was very shocked to encounter the following sentence in a widely used template: “Like most forms of psychotherapy/counselling, it can make you feel worse before you start feeling better and the changes you experience may create conflict in your close relationships.”

Ethics

Firstly, I question the fact that MOST forms of psychotherapy/counselling (online or in-person) have this effect. Secondly, I question the ethical basis for using such forms of psychotherapy/counselling. Especially, when there are approaches available that will NOT have this effect.

I can understand when potential users of psychological services have this idea. Most exposure members of the general public get to therapy, are through the popular media and movies. These portray the limited number of therapy modalities that were available way back when. And of THESE, it is most probably true that most have the effect, as described in this template. However, this is not true for many approaches developed and used since then. That is why I am shocked that this view is further perpetuated by professionals within the psychological field.

Views of therapy

This is just one more reason why potential clients of psychological services are reluctant to enter therapy. For someone with this preconceived idea it must be extremely hard to enter therapy. Furthermore, even more so if this is confirmed and communicated by the professional through formal documentation. And once he/she has decided to enter therapy, the reluctance, or even dread, he/she enters therapy with.

A therapist-mentor told us a while ago of an incident in his waiting room that illustrates exactly, this. He often sees more than one client at a time: couples, families, business partners etc. So, when on this day he entered his waiting room, seeing two ladies sitting next to each other, he expected that he will see both. The one was visibly distressed and the other calm and composed. Only the distressed lady got up (turning out to be the client). She left the other seemingly reluctantly. Consequently, he offered that the other lady may join them. The client then explained the presence of the other lady. She only asked her friend to come with, because she expected that the therapy (not her presenting problem) would upset her. Added to that, to such an extent that she will not be able to drive!

It saddens me that clients must enter therapy with the expectation of “No pain, no gain”!

Hope

I am not saying that other therapies lead to guaranteed improvement. However, the least any kind of therapy should NOT do, is to add to the client’s existing distress. These are general ethical principles in all health professions. Namely, benevolence (increasing well-being) and non-malevolence (doing no harm).

At best, clients can enter therapy with hope and positive expectations. Simultaneously, knowing that it may not lead to the disappearance of their symptoms. I believe we owe it to our clients.

In conclusion, this should not be an unrealistic expectation. There are various forms of therapy/ counselling available that make this possible.

Listen to my No pain, no gain video on my Facebook page about this topic.

Ethics