Dear Therapist:

My husband had a rough childhood. His parents were very "old school" and harsh and critical. This has led to a general lack of confidence and low self-esteem which is prevalent in everything he does (or doesn't do). He has been in therapy for two years and says that he finds it very beneficial. However, as an outside observer, I don't really see any change other than him creating a narrative for his problems. He understands why he is how he is and how his life was impacted by his childhood experiences. I hear that. But this just increased awareness of his life story doesn't really seem to change anything—if anything it just gives him more of an excuse to not move forward in life. Is this how therapy works? Wouldn't it be better if there was a way to focus on the present and dealing with overcoming his current challenges? It seems analogous to having a flat tire and spending all your time figuring out why it's flat as opposed to just changing the tire! If this is the way to go I will support it. I just wonder if there is another way?

Response:

It can be difficult to evaluate the efficacy of therapy from an outside perspective. Despite your observations, it’s possible that your husband’s self-esteem has, in fact, gotten better. He may feel better about himself without an obvious change in his behavior. Your husband may be acting similarly to how he always has, but the reasons for his behavior may be different. For instance, if his self-esteem is better, he may be doing things more from habit than from a lack of self-esteem.

If this is the case, your husband’s actions may begin to change over time. If they don’t, the issue can be viewed separately in terms of how you and he are individually affected. If the benefit that he sees is (as you suggest) simply with reference to his understanding of his feelings—but there is no change in his general mood or ability to deal with issues—then therapy hasn’t (yet) helped him in a concrete sense. Your husband, however, may convince you of actual continuing improvement in mood and self-esteem. If so, your remaining concerns may be related to your own needs, or to issues within your relationship.

Has your husband described to you what it is that he believes has changed for him? If not, perhaps you can ask him to be more specific about how therapy has helped him. If he is able to identify areas in which he has seen improvement, you may have a better understanding of his achievements and future goals in therapy. If not, your concerns about his lack of discernable improvement can be discussed. I don’t know your husband, and I’m not familiar with your relationship, so I don’t know whether this is a conversation that you can have—or if you might be able to have it together with his therapist.

Ideally, therapy should focus on both underlying causes and direct change. The improvement that your husband sees may actually be only cerebral—and he doesn’t really feel better about himself. If this is the case, your concern is warranted. Introspection and heightened self-awareness (including of unconscious impulses and triggers) can be an important part of therapy—but it is usually a means rather than an end. If it becomes clear that your husband’s gains in therapy are not translating to practical improvement, discussing this with his therapist and with him can help them both to refocus on therapeutic goals.
                                  

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317

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