Originally known as “the talking cure,” therapy these days is often understood through what’s called the medical model. The medical model views counseling clients as if they were patients going into a doctor’s office: you (the patient) have an ailment and the therapist (doctor) diagnoses you with a particular disorder based on your symptoms and then treats you with therapeutic techniques or interventions matched to that diagnosis. The medical model is the reason health insurances will often pay for therapy and it’s the predominant way of thinking about counseling in our country.
Brennan Mallonnee, LMHC is a therapist in Somerville, MA.
The medical model has yielded some great advances in treating mental health challenges. For example, antidepressants and mood stabilizers can be life-saving for those struggling with suicidal depression. Thinking of mental health challenges as an illness rooted in the brain has also helped normalize the experience for many people; for example, by helping someone struggling with anxiety to understand that it is not their fault and is not a character flaw.
The medical model has been useful in some ways, but I’ve found that it doesn’t come close to explaining the work that my colleagues and I do and how powerful it can be for clients. Instead, I’d like to tell you about another way of thinking about therapy, one that I’ve grown into over more than eight years in the mental health field and working with hundreds of clients. In this model, I see therapy as a spiritual practice.
Every single client I’ve seen has been in emotional pain of some sort. Even those whose mental health challenges clearly have a genetic or biological component are also affected by situational factors and bring with them their experience of emotional pain. Clients arrive filled with shame, or believing that they are not good enough, or that they are unlovable and unworthy. They are hurting and they don’t know whom to share that hurt with or how to move through it and regain a sense of themselves.
A good therapist can offer information, coping skills, and new ways of thinking about problems. But in order to do that, they must first provide something much more important: what the psychologist Carl Rogers called “unconditional positive regard.” This means a deep respect for the client as an individual who is doing the best they know how and who has the right to decide for themselves how they want to live their life.
Many types of counseling are based first and foremost on the therapist providing an environment of unconditional positive regard for the client. This means that many kinds of therapy think that the relationship between the therapist and client is the most important thing, more important than any particular technique or intervention the therapist could offer. Research shows this to be true: by far the most important factor in the effectiveness of any therapy is the quality of the therapeutic relationship. What sort of medical service is this where the relationship with the provider is far more important than the treatment provided?
When a therapist offers a client unconditional positive regard, something different starts to happen in the room. It’s impossible to quantify the power of being accepted for who you are: of being seen, truly and deeply; of being respected as an independent, autonomous person with the power to make your own choices. Sharing your pain and having the seemingly most broken, hurting parts of yourself accepted by another human being is powerful medicine. Clients begin to feel comfortable in their own skin and their emotional pain begins to heal when they experience unconditional positive regard.
This is why I’ve started to see therapy as a spiritual practice. When we bare our souls and share our pain and shame, when we open ourselves to being accepted fully and non-judgmentally by another person, we are doing something deeply spiritual: we are connecting with a fellow human and learning how to be open to connection with all living things. In a world where the people around us often react to us out of their own needs, wants, and hurts, we go to therapy to be in a space where we are warmly accepted and our pain is taken seriously. When we do this, we start to be able to live this way in the world: full of compassion for ourselves and others, able to manage the pain we inevitably feel as we move through life.
“In a world where the people around us often react to us out of their own needs, wants, and hurts, we go to therapy to be in a space where we are warmly accepted and our pain is taken seriously.”
Sometimes therapy can move into more intentional spiritual work, as well. Humans need meaning and purpose in our lives. Without those things, we struggle with feeling stagnant, unmotivated, or even depressed. If we don’t have an idea of who we are on a deep level, what we see as our purposes, and what our life means, we can feel stuck and unhappy.
There are lots of definitions of spirituality, but for me the heart of it is the answer to these three questions: What are my deepest values? What is my purpose in life? What is the meaning of my life? Spiritual work in therapy might mean exploring these questions by considering what brings you joy and makes you feel alive, what gives you a sense of purpose and leaves you feeling fulfilled, or what makes your life feel meaningful. In finding the answers to these questions deep inside you, you can come to feel a greater sense of peace, strength, and resiliency to face life’s challenges.
Most people who come to therapy are looking for help with the pain they’re experiencing. When we broaden our understanding of what therapy can be to include mind, body, and spirit, we open up the possibility of using therapy to help build a sense of meaning and purpose in our lives.