The “Tools” of Therapy
What Do We Mean When We Ask for “Tools” in Therapy
“I just need some tools.”
How many times do therapists hear this plea from clients? So, so many times.
I’ve begun to wonder — and gently have started to ask clients — “What do you mean by ‘tools’?”
Because I’ve realized that I don’t know what they mean, and I suspect, neither do they. That said, I’d bet that what I mean by “tools” is different than what they mean by “tools.”
Clients sometimes think of therapists as magicians, with a bag of tricks stuffed under our chairs and a list of tips hidden in our pockets. I have had clients intimate that I am sadistically holding back some spell that will relieve them of their suffering; that they need to find the right abracadabra that will grant them access to all my secret charms.
I get it. When I am struggling along with a client, when I am in their pain with them, I sure as shit wish I had a magic wand up my sleeve.
When clients tell me they would like to have “tools,” I think of some who tell me something about themselves they would like to change, then ask, “What should I do?” For instance, “I get so jealous of my friends who have boyfriends. What should I do?” or “When my wife and I get into an argument, I just shut down. How can I stop doing that?”
Sometimes, depending on the rapport I have with clients, I can bring humor into it. “Well, don’t be jealous!” or “Stop shutting down, of course!” Then we chuckle, ha-ha. But there remains a lingering sense of disappointment in the room.
The trouble with questions like “What should I do?” is that they smack of advice-seeking. Sometimes I do dispense advice. If a client tells me that they want to speak to their partner about something vulnerable, I remind them to choose their timing for that conversation wisely. Or if someone feels overwhelmed by the amount of tasks they need to do, part of what I offer is helping them prioritize. But even in these cases, the work centers more on the myriad emotions around a client finally attempting to be vulnerable; or why, in the second example, the client has so much trouble saying “no” to anything.
There are some issues that can be helped with what I think clients mean when they say “tools.” For instance, I have protocols for clients to help them through panic attacks, for sleep problems, for remembering to take medication, to reduce stress, and such. I refer to those tools as Band-Aids. Which is great. Band-Aids are useful. Everyone should have a box of Band-Aids.
But here’s the thing: As with Band-Aids (my clients will attest that once I latch onto a metaphor, I’ll tug on it far longer than I should!), which anyone can buy at the store, these tools can easily be found on the internet. It can be helpful, as with Band-Aids (see?), to have some assistance in applying them, so discussing these tools in therapy is helpful. But if you keep getting the same cuts over and over, it might be time to try something different. Might be time for a different type of tool.
As a psychodynamic-oriented therapist, my work focuses on a deeper understanding the source of the panic attacks, sleep issues, “forgetfulness,” and stress — or anxiety, depression, relationship stuff, etc. That means gently opening some wounds so that we can find the infection, clean it out, stitch it up, and start the healing process with as little scarring as possible.
What tools help us do this? When I think about tools, I think about things that are hard to find on one’s own, but that are far stronger and longer lasting than Band-Aids and, ultimately, minimizes the need for those Band-Aids.
When I envision helpful tools for my clients, I think about what will strengthen their capacities. One basic tool developed in therapy is the capacity for self-reflection. Clients who have trouble with this tend to overly externalize their problems — blaming others or wanting to change others’ behaviors without trying to understand how they themselves might be contributing to their own suffering. Alternately, they get caught in a cycle of self-blame and self-deprication without considering any external or other forces at play can keep clients stuck.
Being able to reflect on one’s own feelings, thoughts, and behaviors, in a curious, non-judgmental way is often the foundation for work in therapy. Reflectiveness is an important tool that leads to deeper self-understanding and self-compassion.
A similar tool called mentalization refers to the capacity of understanding not just one’s own state of mind, but understanding that other people have their own subjective states of mind. Some of you reading this might say, “Of course other people have their own states of mind.” But some people are often very confused by other people’s beliefs and behaviors when they appear to conflict with their own. People with social anxiety tend to have trouble with mentalization. People who project their own feelings and thoughts onto others also tend to lack this capacity. And those who have difficulty regulating their emotions or who are unhealthily impulsive tend to have difficulty mentalizing.
Self-expression and self-acceptance are two important tools for clients to develop and hold onto. Self-expression — expressing one’s Self — is something many people aren’t used to doing in their relationships. I don’t mean just venting or getting angry and yelling. When you can reflect and mentalize, then you can talk about yourself with clarity, honesty, and without shame. You can understand your wants, needs, and desires, and feel confident in sharing those with important others. The flips side of that is being able to hear other people’s wants, needs, and desires and navigating places of difference or conflict. In other words, empathy for self translates into empathy for others. Self-expression and empathy are vital tools in healthy relationships.
Self-acceptance can be a tough place to get to. “Acceptance” doesn’t negate change. Statements to embrace are: “This is where I am right now. This is who I am right now. There are things about myself I want to keep. There are other things about myself that I want to change.” Some folks have difficulty accepting the “dark” parts of self. Feelings like anger and hate, envy and jealousy — these are human emotions that everyone has. The work of minimizing those feelings starts with accepting that we feel them in the first place. Sometime clients need to accept that they’re not perfect, or that they’ll disappoint someone someday, or that they need to grieve, or that they need to let go of some dreams (and develop new ones).
All of which leads to one of the most useful tools a client can carry: Tolerance. I use the word “tolerate” a lot with my clients. I help them tolerate difficult feelings, like sadness and disappointment and the pain of grief. I help them tolerate other people’s feelings. I help them bring their anxiety down to a level they can tolerate. If your window of tolerance increases, you are less likely to experience explosive emotions, you are less likely to shut down and withdraw. You can make room for more varied emotional experiences, you are more likely to share vulnerabilities with important others. Within a wider window of tolerance, there is more room to move (get unstuck) and more room to grow within yourself and within your relationships.
Unlike the Band-Aids (they’re back!), which I can hand to you, these tools take shape within the therapy. Ideally, these tools are acquired in childhood in a safe, loving relationship with caretakers. But people who come to therapy most often have not had that experience, and so these tools develop within the safe, empathetic, loving therapeutic relationship. We build them together in a way that makes sense for you, based on your unique circumstances and the strengths that you bring to the table.
So if you ask your therapist for “tools,” make sure you both know what you mean by that. And remember: Self-reflection, mentalization, self-expression, empathy, self-acceptance, and tolerance aren’t always easy to acquire, but once you’ve got a few of those in your toolbox, you’ll be well on your way to building a healthier, more gratifying life.