Sometimes when I ask people about their goal of attending therapy, they might say that they want to get rid of negative thoughts and feelings, such as anxious or depressive thoughts. At other times, they might say that they want to get better at dealing with certain situations.
If the goal is to get rid of negative thoughts and feelings, avoidance can be the best and most effective strategy (at least in the very short run). On the other hand: If the goal is to get good at handling anxiety-provoking situations, then exposure is a more effective strategy.
As a metacognitive therapist, I call this the difference between having an internal goal or an external goal. Here are two examples from the therapy room to illustrate the difference: Is my goal to be able to perform an upcoming exam while feeling nervous (doing is an external goal), or is my goal is to be less nervous while performing (feeling is an internal goal). The difference is actually huge!
You might see how the willingness to be emotionally exposed is necessary to achieve confidence in one’s ability to handle those emotions. It can be tough but still personally rewarding as one grows confidence in one’s ability to do stuff (see self-efficacy beliefs).
Since life is full of both ‘ups and downs’, getting good at handling those inner experiences seems like a more sustainable goal to have in general. In therapy, it is necessary to agree on the goal of therapy so that the commitment to therapy is strong both inside and outside the therapy room (homework is often necessary, too).
The reason that the goal is so important is that all therapeutic exercises, even exposure exercises, can be used in ways that will backfire over time, potentially leaving you with a sense of not benefiting from therapy.
For example: “I exposure myself to this situation, so that the feelings can pass over time.” But should this be the primary goal, or should it be a secondary gain?
This kind of habituation rationale is the rationale for exposure experiments in cognitive behavioral therapy (CBT). However, in metacognitive therapy, we do metacognitive exposure where the goal is to get good at handling that situation while feeling nervous. This means that we practice attentional control in the situation and we practice leaving thoughts and feelings alone (so-called detached mindfulness).
In my opinion, an empty promise exists in Western cultures that “feeling good” is something to aim for (read my post on this matter, Happiness is an Empty Promise), which may seem reasonable on the surface. I like feeling good as well. However, people often seek help in therapy because they cannot achieve this goal in their lives. Instead of trying to feel good, we should perhaps try to live life fully in ways that we find meaningful. Living life this way may involve unpleasant feelings just as it involves pleasure and joy.
Think about it: When we connect with others and care about them, we are going to experience losses, perhaps abandonment and rejection. When we buy material stuff, we are going to risk the investment and our savings. When we care about doing things well, it is going to hurt when criticism hits. Parents know that their kids are going to leave them at some point. Well, in that light, it is difficult to imagine a life without unpleasant emotions.
As you probably already noticed, “getting rid of” can backfire in the sense that we tend to pay more attention to things that we want to get rid of. So, instead of getting rid of, we try to get good at having unpleasant inner experiences and still do the stuff that we care about. We want to live life fully.
This post is the fourth part of the series “Inside the Mind of a Metacognitive Therapist“. You might want to catch up on the other parts as well. I hope that you found it useful. See you around.