Is it a therapist's job to make the client feel better or see reality more accurately? originally appeared on Quora - the knowledge sharing network where compelling questions are answered by people with unique insights.
Self-deception serves a purpose. It addresses underlying needs, but with potentially short and unsatisfying results. Anyone who has believed they can quell hunger with a bag of chips, instead of a real dinner, knows the feeling - you may be temporarily full, but you're not satisfied.
Helping clients understand and fulfill their needs in an enduring, satisfying way of making self-deception unnecessary. Thus, seeing reality and feeling better typically go hand-in-hand. But until self-deception's function is addressed, the belief that a therapist can help someone see reality may itself be an illusion.
In 1997, the Heaven's Gate cult showed the world just how tenacious self-deception can be. Thirty-nine members of the cult committed suicide because they were convinced that a spaceship would take their souls to heaven. A few days before their suicides, cult members purchased a $3,600 telescope, only to return it with claims of device faultiness.
Why did cult members commit suicide even after being presented with actual evidence that should have, in theory, discredited their beliefs? To understand the concept, it's important to comprehend the nature of self-deception and why it takes root.
Self-deception gets a bad rap, but some self-deception is healthy. A toddler who feels Teddy is real is meeting a need for comfort and is not suffering as a result. Repressing painful truths, like aging and death, can be an adaptive way to cope with an otherwise overwhelming reality. However, the more severe the deception, the higher the cost.
The Heaven's Gate cult members likely suffered great emotional pain before they ever joined the cult. The cult's appeal was its ability to fulfill some crucial needs. The exact type of need was probably different for each person - perhaps a sense of meaning or unconditional love. It's tough to trade in this fulfillment, even if it's temporary, false, and ultimately harmful, for a reality that feels bleak.
In psychotherapy, I often work with clients who distort reality somewhere between the two aforementioned extremes. A patient with an eating disorder, for instance, may be convinced she is overweight. This fabricated reality enables her to focus on something within her control (weight). If she feels that her body is the only thing over which she has any control, the belief that she is overweight is serving an important purpose.
Although one may be tempted to show this client a BMI chart to prove she's thin, the evidence is unlikely to be effective. Assuming the disorder is not life-threatening, I could instead help the client develop agency in other parts of her life. As we work together to satisfy the patient's underlying needs, the need to control her weight will likely diminish, along with the illusion of being overweight.
There are many ways to help a client see reality. Sometimes this is done by directly questioning the client's constricted view (e.g., "is there any other possible reason your friend didn't confide in you?"). Other times, it's not feasible or practical to directly challenge a belief. In these cases, psychotherapists can help clients understand their underlying needs. Then, they can work together to replace self-deception with a more adaptive, fulfilling alternative that's rooted in reality.
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