“I just do EMDR.”
“Once I found internal family systems, I never had to read another book.”
“Anyone who doesn’t do transference analysis is doing lie therapy.”
I’ve actually heard people say these things!
Can you imagine a carpenter showing up at a conference and saying, “I just work with a hammer.” “Once I found the screwdriver, I never had to use another tool.” “Anyone who doesn’t work with a ball peen hammer is doing lie carpentry.” He would be laughed out of the hall. Yet every day therapists fall into the trap of idealizing one technique.
Growing up in my father’s blacksmith shop I learned that every tool works until it doesn’t. Then you better have another tool and another approach. My father didn’t have just one hammer, but dozens. He didn’t have one wrench but many types and sizes of wrenches. We could weld iron in the forge or with a stick welder or a metal inert gas welder. We could weld aluminum, but with a torch. We could weld cast iron, but that took a torch and bronze rods. We could work with copper too, using solder. You get the idea.
As a blacksmith working with my dad, I had to be able to work with any kind of situation a customer brought into the shop. Cars, trucks, farm implements, ornamental iron, we fixed them all. But it required flexibility, creativity, and lots of tools.
From the forge to the therapist’s office has been quite a journey, but I’m also struck by the similarities. We are asked to fix. We need to recognize the unique problems posed before us. We need to be flexible because no one approach works all the time with every person.
If your car mechanic told you he could do everything you wanted done to your car by using his hammer, you would race to the next repair shop. Yet every day therapists offer to help patients by using a single tool, as if it has magical powers.
Don’t get me wrong. Interpretation can be fantastic. EMDR can be extremely helpful. And mirroring as in focusing can be exceptionally helpful for some people. But when we offer only one tool and expect everyone to benefit, we set ourselves up for disappointment.
Every technique works until it doesn’t. And when it doesn’t, you better have another approach in your hip pocket. Nothing works with everyone all the time.
So let’s see how to recognize ritualism.
1) Oversimplification: “All you need to do is ___.” Some psychoanalysts have said that all you need to do is interpret the transference. Some people say all you need to do is hypnosis. Others say all you need is mindfulness. Some ISTDP clinicians have said all you need to do is pressure and head-on collision. I don’t know which world they live in, but it’s not mine. We work with people who are incredibly complicated. Yet some suggest that a single technique will heal all disorders. Not true. Every technique is useful at what it does, but patients usually need help in multiple areas requiring very different kinds of therapeutic action.
2) Repetition: “When it doesn’t work, just do it again.” Rather than choose a technique or approach based on the patient’s need, the therapist just keeps repeating the technique, even if it doesn’t work. Then technique becomes a Procrustean bed. We try to stretch or shrink the patient to fit our technique. Instead, we need to stretch ourselves.
3) Technique is equated with a theory: Mindfulness, EMDR, and interpretation are valuable techniques. But none of them is a therapy. A therapy model requires a theory of development and a theory of assessment, which allows the therapist to choose techniques suited to the patient’s need in the moment. When a technique is mistakenly equated with a therapy, there is no need for a theory of development or assessment. There is no need for multiple technical skills. Ritual (repeating a technique) becomes a substitute for thought (assessment).
4) Claims of power: “This technique is very powerful.” Every technique is powerful until it isn’t. In fact, every technique is powerless much of the time because it is not suitable. What is powerful is not a technique but the process of assessing the patient’s need, which allows you to offer the right interventions at the right time with the right patient.
5) A messianic vision: “This technique will change the world.” A well-known therapist made this claim at a recent conference. No technique or therapy will change the world. We help most people some of the time in some parts of the world. And that is no small accomplishment. With each generation, new traumas occur leading to new emotional difficulties.
So why do we seek omnipotence and grandiose fantasies through ritual?
If we accept mere competence, we face our inevitable limitations and those of our patients. We face the limits of reality and death. The grief and loss over what we can and cannot do is part of growing up. And rather than face the losses and limits inherent in life, we yearn for manic fantasies where we are omnipotent instead of merely competent, omniscient rather than knowledgeable, changing the world rather than helping one person at a time.
Doing therapy well is difficult, requiring years of study, practice, supervision, personal therapy, and hard work. It takes time. Ritualism is a form of magic. It happens now! Rather than face the limits of reality, who wouldn’t want a magical solution?
We can only do what we can, with the capacities we have, with the people we are with, in the place we are in, with the time we have. Modest perhaps, but realistic, and also loving of our patients.
When we try to do magic, we ask our patients to have magical results so we can feel like magicians. Thus, we doom them to fail, sacrifices on the altar of our narcissism.
Instead, when we shed ritualism and turn away from the siren song of magic, we can offer genuine help so the patient can achieve what is possible within his limits and capacities. And once we drop our ritualism, we move from formula to genuine encounter with this mystery known as our patient. And once we drop the idealization of any technique as the “final” answer, we can become perpetual learners, open to whatever anyone can teach us.