One thing I have learned after three years of seeing clients is that the “presenting problem,” which is what clients say is the cause of their suffering, is usually not the problem that needs to be worked on. The presenting problem is often a psychological defense against the therapeutically-important stuff -- a defense that, when it was created, was actually a solution.
Psychological defenses are the ideas, behaviors, and relationship dynamics we adopt in order to avoid psychological pain. Often, defenses are very simple. For example, someone who is mortified of rejection might avoid taking risks. Someone who went through a traumatic event may avoid talking about it, thinking about it, or even exposing themselves to elements of it (people, places, or things). Other times, defenses can seem convoluted, e.g., person with homosexual attractions sleeps with and brags about sleeping with many members of the opposite sex.
When people come into therapy, it is usually because their defenses—which at first protected them from psychological pain—are out-of-tune, out-of-touch, or otherwise awkward to their current situation. For example, the person who avoids taking risks in order to avoid rejection might one day discover a desire for something that involves risk (e.g., finding a partner). Suddenly, their defense is squarely in the way.
Ineffective and insensitive therapy is that which underestimates the power, value, and uniqueness of defenses. These therapies simply encourage people to change their defenses, with little to no regard for what will happen if this is done too quickly. A nuanced understanding of defenses recognizes that while the defense itself is often the presenting problem—e.g., I’m having a hard time dating—it is actually what made the defense necessary that must be worked through—e.g., fear of rejection—in order for a newer, more flexible defense to take its place.
Of course, casting aside our defenses in one fell swoop is a bad idea, because it leaves us completely vulnerable to all the psychological material that is harmful to us. A better approach is to use the therapy hour as a safe environment in which the defense may be shelved for 45 minutes and the underlying material worked through. After session, clients should feel welcome to put their defenses back in place; the reality is that they still need them. Defenses fall away like ripe fruit from the vine—very easily when the time has come.