Helping the patient make sense of themselves (these are the 40-somethings who say "I got this diagnosis and I'm so relieved") and to untangle twisted knots of emotion, lies, mis-direction and denial, are what television and movies would have us think are the basic tasks of psychotherapy. But the story-construction is only part of it, even though it may be so much that both patient and therapist fall down in exhaustion when it is done.
The other part is giving the patient a life that works and keeps the dark thoughts at bay. "Managing" the dysfunctional behaviours and thoughts is not quite enough: it is better to displace them. It's at this stage that I think the psychotherapists fall: it's not enough to feel no pain (though that may be enough for a while), we need to feel good as well. (Martin Seligman recognised this, and became a self-help guru as a result.)
Psychotherapists fail at this because they have the wrong data. Day after day, people pass through their offices telling them that they are upset because X and Y or they they would feel better if only W and Z, and unsurprisingly, the therapists conclude that they would be out of business if everyone felt / had W, X, Y and Z, because they would also be happy. So they tell people that they need W, X, Y and Z.
Whereas what their patients need to be is the kind of person to whom other people respond with W, X, Y and Z. They need to be loveable people, and then they will be loved. They need to give off "I'm a great person to hang out with" vibes, and then people will hang out with them. And of course, that's exactly the kinds of person the patient is not because (see story they have constructed with their therapist), and how to be that kind of person is exactly what they want the therapist to tell them. However, that falls under the heading of "self-help" and that's not what therapists think they do. It's what therapists think Dale Carnegie did.
It is much more effective to change what one does on a daily basis so the dysfunctional behaviours have few opportunities to get appear. These techniques are well-known in the self-improvement community: hit the gym / swimming pool / running track / dojo (according to taste); dump the users, losers and abusers; early to rise so you have to go early to bed; cut down on the booze and fast food, and drop the drugs; listen to upbeat music; read non-fiction and/or learn some saleable skills; and so on. Holidays on one's own work for some people, not so much for others. (Talking briefly to strangers about something harmless is a ninja move: you will come across as open and friendly, and they will feel bad because they thought you were some creepy weirdo, but then you weren't.) The trick is not to do things that you know you're only doing so that you don't do something worse - this is where some re-framing can be useful.
Whatever one chooses, it has to be something that can be done with or without another person. That endless search for "intimate relationships" and "like-minded people" depends on finding someone else - and if you're over thirty, the chances are she / he is already in a committed relationship ("the good ones are always already taken"). The therapist who implies that the client will never be truly happy until they find that elusive "intimate relationship" and those mythical "like-minded people" is not doing the client any favours.
Self-improvement is easier for people who are not in domestic relationships. After thirty-five that's only fifteen per cent of the (UK) population. Everyone else has to get better despite their live-in partner: partners cannot be assumed to support the changes we want to make, though it's nice if they do. To the extent the domesticated cannot work the full self-improvement program, they are stuck with "managing", and so with being their own hazard.
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