It is not a recipe: Embracing the uncertainty of psychotherapy
“Thriving in uncertainty is an art. It requires a canvas of courage, strokes of adaptability, and the colors of resilience to create a masterpiece of a fulfilling life.”
- Unknown
As uncomfortable as uncertainty can be, it is a key ingredient to a fulfilling life. Unfortunately, I do fear that we have lost the ability to sit with the discomfort of uncertainty. We live in a world where every problem in life is approached with a 5 step programme or some quick fix, promising to deliver some radical change within a set period of time. Certainty is then further solidified by testimonials, money-back promises, and authority endorsements. Sadly, these unrealistic promises breed unrealistic expectations.
Arguably, these unrealistic expectations are also largely as a consequence of the proliferation of the prevailing message within the self-help industry where “everything is fixable!”. People tend to read a book or listen to a podcast and then apply the exact same step-by-step process to their own life expecting it to work for them too. These illusions of certainty help people escape the anxiety associated with their fear of uncertainty. The more we escape uncertainty, the more we fear it, and soon everything in life starts to feel anxiety provoking. Life is inherently an uncertain experience. As the famous saying goes, “The only certainty in life is its uncertainty”. You cannot expect to go through life by trying to avoid it. By constantly escaping uncertainty you are providing the evidence to your brain that you cannot handle uncertainty. You also rob yourself of the opportunity to build self-trust and self-efficacy.
If you think about it, decades ago, we embraced uncertainty. We looked forward to taking road trips or trying new restaurants without knowing what the menu looked like. But these days we want to know everything! For example, previously, if you wanted to try out a new eatery for lunch, you would call up few friends or family and you’d meet at chosen place. These days, you first Google the eatery to see what the ratings are, what the menu has to offer, how many vegetarian options it has, how far it is, and do a quick Google 360 view. To top it, you Google what the weather will be like on the day, how far it is, and.. and.. and. So many decisions before even considering extending an invite! By doing this we are slowly (or not so slowly anymore) outsourcing our power, our sense of agency.
It is then not surprising that this need for certainty also shows its face in therapy. There are a few things in therapy that make me sigh internally as much as that moment when a patient requests a step-by-step process of how we are going to “fix” their problem(s). Requesting a plan-based solution for the duration of their sessions. This request for an action plan not only disregards the acknowledgement that they themselves are deeply complex human beings, but it also reaps the entire psychotherapeutic process of its richness, leaving it largely superficial and robotic-like.
These patients are, however, not to blame as we now live in a society that has become so accustomed to receiving the quick fixes. Providing the illusion of some certainty. So, when I am presented with the expectation of a laid out action plan for therapy, I brace myself because what I will explain to the person sitting in front of me will either hit home, or they will politely seek their step-by-step action plan elsewhere, or they will embark on the process only to claim a few sessions in that psychotherapy is “not working”. Let me just say, kudos to those who terminate therapy prematurely as they do not experience a good therapeutic fit. That takes courage and vulernability! So, I am not referring to those cases. I am referring to the cases where patients come into therapy with the expectation of an action plan to “fix” the problem and then prematurely exits the process because therapy is not “working”.
As a psychotherapist, managing this balance between providing some therapeutic framework whilst embracing the unknown territory of the psyche can be really challenging because at its core, psychotherapy is uncertain. The entire process! Let me just highlight that psychotherapists generally have some therapeutic plan when they work with a patient, however, this does not entail actionable steps following each session. That would more resemble coaching, which I also offer and hugely supportive of. It has its place. But therapy unfolds over time. Just as you want to get into shape, which happens over a period of time. So is therapy, a process from which you only reap the rewards over time. Therapy requires the courage to engage in deep self-enquiry. To tap into the emotional part of who you are, not just the cognitive part. In fact, I think we tend to live too much in our heads, failing to connect to our bodies and our human experiences. I do acknowledge that when therapy is curtailed by a limited amount of sessions, the process does take on a solution-focused approach. However, even then, therapy is not prescriptive.
This need for reducing complex psychological phenomenon into a simplistic step-wise solutions is what often leads to the teachability bias. A concept beautifully explained by Jane Elliot in her article “The Trouble with Teachability”, where we want to teach things that are frankly not ‘teachable’. How do you teach something that has resulted from a culmination of unique past experiences, neuronal connections, and salient emotional states? To follow such a reductionistic approach to therapy would have some costly implications. I will try illustrate this.
Let’s say we have both Maggie and Pete who enters therapy wanting to deal with their burnout.
- Maggie: Female, who is an introvert, highly conscientious, with a work ethic that even Hitler would’ve been proud of, but also has a history of failed relationships and depression. She is burnt out due to people-pleasing, prioritising work, and not being able to say no to social and work events for the fear of missing out.
- Pete: Male, who is an extravert and a great problem-solver, but also struggles with high impulsivity and deep-rooted insecurities. He is burnt out due to his impulsive nature and always saying yes to going out with his colleagues or mates and not prioritising his responsibilities adequately. He ends up neglecting life with his family (a core value for him), as well as his health, and struggles to perform in his high-demand work environment.
It over-promises and under-delivers
So, if Maggie and Pete were to be given the exact same approach (i.e., step-by-step therapy plan) it would fail dismally. Why? Because let’s say both therapists follow a “therapeutic plan” that prioritises social life, and therefore, suggests more social engagement. For Maggie, as an overextended social introvert, she needs to actually prioritise recharging by spending time alone, whilst Pete likely needs to spend more quality time at home with his family. Similarly, Pete’s impulsivity and insecurities are also likely to get the better of him with a set-in-stone plan, and will forgo sticking to the plan. For Maggie, if her underlying perfectionism is not addressed she will unconsciously abandon any plan aimed at lowering her perfectionistic mask, which is at the root of her burnout.
Not so easy, right? That is why psychologists actually do get trained for this kinda stuff. These deeply psychological complexities cannot be address with some coaching strategy. As I noted above, coaching has its place! But unlike therapy, coaching is very action-orientated. With coaching, you know where you are going, whereas with psychotherapy, you are not following a map, you are drawing the map yourself. The psychologist just helps you figure out how you want to draw the map and will give some practical tools, like a pen and paper. But the drawing, that’s entirely up to you.
It eliminates a person’s unique strengths
When you prescribe in therapy where someone should go, you are not allowing them to think creatively and come up with their own ways of dealing with life’s challenges. This means that if the plan stops working, they will end up in a puddle of self-loathing, drowning in their own self-criticism. Just hammering in the belief that “I cannot do life on my own”, “I am failure”, “Nothing I attempt ever works out”. Meanwhile, the plan was never even their plan! So that is justified punishment. Secondly, when the plan stops working, they will look outwards again for plan B. Not look inwards. The plan would have failed them in developing self-trust. Alternatively, if they were to tolerate and work through the uncertainty of therapy and formulate their own plan, they will have the confidence, self-belief, and courage to formulate plan B should plan A stop working.
It takes agency and autonomy away
I’ve also learnt that generally those individuals seeking a plan of action are also generally those who lack a sense of agency and self-efficacy. They have been people-pleasers most of their life, or have looked externally for where to go next. Why would therapy then be any different? There too, they will seek outward guidance. Growth within the self will only take place if the discomfort of uncertainty is endured. When choices are made for the self, by the self. When mistakes are made and failures embraced. Only then can the self be reorganised in a healthy way.
It strengthens perfectionism
Those prone to perfectionism have an inherit need for certainty. A need for a plan. A need for control. An action plan in this instance will fulfil all these needs. It will give the illusion of certainty, agency, and control by knowing where they are going and what they must do to get there. Additionally, following someone else’s action plan will just strengthen the deeply ingrained “should” voice. They already live life telling themselves what they “should” be doing. So, do we really want to give them a plan to tell them what they should do more of? Strengthening the exact thing that they need to be relinquished from? I believe, in life, there is essentially only two “shoulds”: 1) You should breathe and 2) you should go to the bathroom. But honestly, even those are optional.
As you can see, a “fixing” process is the exact opposite to what perfectionists really need. They need to learn how to look inwards. To trust themselves. To make mistakes. To forgive. To show self-compassion. To embrace uncertainty. To let go of control. This is tough! Hence, not the most popular choice. I predict choosing to sit through the discomfort will be as painful as trying to breakdance on a bed of Legos.
It robs responsibility and ownership
Finally, when you outsource your decisions to others, you tend to also outsource your consequences. People fail to take responsibility for the consequences of their actions if they acted because they were “told to” or “expected to” do so by another. The belief that then develops is one of, “I did this because X wanted/said so, therefore, X should now also carry the consequences of this not working out”.
Overall, having a goal in therapy is great, it gives direction as to what you may want to work on. But as the process unfolds, you need to be open to embracing the uncertainty and letting go of certainty. Allowing yourself to explore aspects of yourself previously masked. Practical tools in therapy are great! For example, how do I improve my sleep? How do I ditch a bad habit? How do I stop being so anxious? Those are tangible outcomes and practical tools can help achieve those. However, these practicalities only form part of the process. They are not the process. When you only focus on the practical aspects of your problem, and avoid self-enquiry, you are in fact just putting a plaster on a bullet wound.
So, if you are in therapy, or thinking of starting therapy, hopefully this will help you find some comfort with the discomfort inherent in the process. Embrace the uncertainty, for therein you will find your certainty.
