When people suffer, they become very focused on getting rid of their pain. That is understandable and very human. When the source of suffering is short-term and acute, this response is also very adaptive and to some extent it is hard-wired, like pulling your hand away from a hot stove. 

When the source of suffering is not acute and/or not short-term, the situation is much more complicated, and here we have choices that will influence the flavor and mood of our lives. Take for example a person who suffers from a chronic illness that creates a lot of discomfort – suppose he or she has chronic back pain. Of course, this person will be wise to invest effort into making his situation better. They would be wise to see a doctor. Maybe the doctor will recommend physical therapy. Maybe the physical therapist will recommend some exercises. But no matter what this person does, the fact will remain that their suffering is not something that will go away quickly. They might have to contend with some pain for a long time. The question then becomes – how should they define their life goals in light of having this pain? Do they become primarily a chronic pain patient, a chronic pain fighter, or primarily whatever it is they were before they were afflicted, such as a parent, but one who now has to parent with chronic pain?

Now, let’s extend this to the realm of mental health. Nature has gifted us humans with an assortment of torturous mental health conditions that can be chronic and desperately painful, as anyone with severe anxiety, depression or an eating disorder can attest. People who suffer from these and other mental health disorders need help and often benefit from good mental health treatment, which often involves medication, but often hinges on therapy. But what should be the focus, or the goal of therapy?

When people first come in for treatment (and I never underestimate how hard it was to even show up in my office to begin with), they often come in with a very human and very simple assumption, which contains within it their expectation from me: “I am coming in so that you will help me to get rid of my anxiety/depression/anger/existential angst etc.” That is their goal for treatment, and it sounds like a very appropriate goal, doesn’t it? A doctor’s job is to get rid of physical suffering, so shouldn’t my job as a psychologist be to get rid of emotional suffering?

As I already said, even with a physical source of suffering if something cannot be treated quickly (like a surface wound or a broken bone), the question of goals and subjective choices becomes relevant. But at least anyone would agree that it is possible (and pleasant) to imagine a world in which a person’s pain is completely healed. But can we really say that about someone’s existential angst? Would I ever be able to say that it is ethical or desirable to rid someone of the doubt or painful memories that cause them to suffer? I am exploring this question as though it were possible, which it is not. But if I could promise you – my reader, that I could wave a wand and rid you, yes YOU, of some part of yourself, even a painful one, wouldn’t you at least think hard about this before consenting?

This is not to say that psychological suffering is inevitable or that is cannot be improved. It surely can improve and I have seen patients of mine improve tremendously. But it does mean that we have to be very careful about how we set goals in therapy. Making someone into a different person who doesn’t feel things deeply is not a good goal. Making this person in front of me – just as they are with all their experiences, memories, and idiosyncrasies suffer less, now that is a good goal, but it implies that we can’t just march in and start condemning parts of a person and trying to throw them out.

When my clients hear that I am not so quick to sign up for the therapy goal of “getting rid of” their anxiety, they become alarmed. “Are you telling me that I finally made my way here and you are not planning to make me suffer less?” To that I say – “No. I do hope that I will help you suffer less. But let us see about the specifics of that plan. When you die, would you like your memorial to say “here lies John who bravely fought against anxiety and finally passed away anxiety-free?””

Well, that would be ridiculous! Most people say, no. They would like it to say that they achieved their career goals, raised their kids well, were kind to their partners, did right by their families and friends, contributed to society… the list goes on. “Well then,” I say. “But a really bad thing has recently happened to you. You have been hurt badly and a person who has been hurt as you have usually (and appropriately) becomes anxious about being hurt again. This anxiety takes time to dissipate, just like chronic pain from a physical injury. Do you really want to wait so long to start going about approaching all those goals you have – advancing your career, having a family – all that?”

“It would be great if I could start working toward those goals, but I cannot because of this anxiety. Now, once you help me get rid of my anxiety – then I will be free to start achieving my real goals. That is exactly why I am telling you that I want you to help me get rid of my anxiety.”

“So, what you are saying to me is that you have all these goals that you are letting slip away from you as a result of your anxiety?”

“Yes! Exactly!”

“And what percentage of your suffering do you suppose is currently being caused by the fact that you know that time is slipping away and you are letting go of your true goals?”

“But haven’t you heard me??? I CANNOT approach my goals. I get anxiety attacks every day. I am nauseous and exhausted all the time. I cannot sleep. Do you expect me to go ask for a promotion when I am like this? Crazy!”

Well now. This is a good start. This is a very good goal for therapy. If you have values and dreams and goals – those are integral to who you are. How about we agree to do absolutely everything we can so that you can go ask for that promotion, anxiety or not. Maybe you will need to practice some skills first. Try an easier thing first, try medication, change your exercise routine. We will surely have to work very hard. But we are working not toward a goal of you being anxiety free – because then what? What is being anxiety free good for? Is it good for being “happy”? But didn’t you say that in order to feel good you would need to have achieved your career goals, been a good parent, seen the world – whatever it is that is true for you? Well – that should start right now, not at some amorphous later point. Remember – your true goal is not to be symptom free. Your true goal is to become able to do those things that you value.