The Goals of Psychotherapy (It’s Not All About Happiness)

I recently came upon the following passage in a journal article. The writer, Muriel Dimen, a psychoanalyst practicing in New York, quotes from an early pioneer of psychoanalysis, someone in the inner circle with Freud, and alludes to the writer Franz Kafka. Here’s the passage that caught my eye:

“Ferenczi writes, ‘It is not within the capacity of psycho-analysis entirely to spare the patient pain; indeed, one of the chief gains from psycho-analysis is the capacity to bear pain’…. If this view sounds cruel, perhaps we might also recall the thought attributed to Kafka, that the only suffering one can avoid is the effort to avoid suffering.”[i]

The sentiments addressed here are dear to my way of understanding the work I do with my clients and to my view of life itself. I have written elsewhere that I do not think the goal of that work is for the client to find happiness. Happiness is an elusive state; one that is impossible to maintain. There is, of course, much in life that generates happiness: love, close relationships, successes great and small. There is much to be happy about: the awe of existence, the absolute miracle of being itself.

But there is much suffering as well. One need not look too far in one’s own life or in the lives of others to see this. There is disease and death; there is poverty; and there are countless losses. The Russian poet Pasternak wrote that “Life is not a stroll across the fields.” And the Buddha, a few thousand years ago, made the fact of human suffering the first of his Nobel Truths. And we know this to be true.

So I don’t think it is the ambition of psychotherapy to help the client be eternally happy. There is much that can be said for helping someone to decrease the amount of suffering. And indeed that was also the Buddha’s point. Some of that decrease in suffering comes from helping the client to, as Ferenczi put it, increase “the capacity to bear pain.” And one of the ways that people most effectively bear pain is by sharing that pain in a relationship. Whether it is through the relationship with the therapist, or through developing one’s intimate relationships outside of therapy, the human bond can provide a necessary salve for life’s ills and hurts.

And then there is what Kafka (no stranger to suffering) had to say. And what he had to say is profound – and similarly echoed in Buddhist literature. There is a lot of suffering that can be eliminated when we eliminate the urge to avoid suffering. Here I have in mind many of the attempts that people make not to feel their pain: addictions of all kinds, extramarital affairs… While the attempt behind these activities may be to lessen one’s pain, invariably more pain and suffering arises. It is strangely paradoxical (something perhaps out of Kafka’s writing), that the more one bears witness to the truth, including that which is painful and causes suffering, the less one suffers.

Sometimes reality can be overwhelming, heartbreaking. At other times, especially when one is supported through a relationship, when one is not alone, it is, even in its darkest moments, bearable, and one goes on. And then there are moments of joy as well…

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