Does Psychotherapy Work? Beyond “Sick” vs. “Well” – From Compartments to Continuum

by Bob Edelstein on March 1, 1994

Our culture has the tendency to label, dichotomize, compartmentalize and objectify. For example, we are either “sick” or “well”. Treatment of illness is for the sick person. Personal growth is for those who are well. Being sick is judged as bad, being well is judged as well. A way to break out of these confining categories is to view existence as a continuum. The labels of “sick” and “well” are arbitrary descriptions of different points on the continuum. As a therapist, I am being with the person, helping them to explore the full continuum of their being, rather than treating illness or causing personal growth.

In the dichotomy of sick versus well, “dependence” is considered “sick”, and “independence” is considered “well”. The thrust of some therapies is to move a person from dependence to independence. Another way to approach the issue is to focus on process, aiming at opening awareness of dependency, exploring all of its ramifications and associations. Dependency is not judged as good or bad. It simply is a part of that person’s life at that point in time. Exploring dependency in an open, discovering, non-judgmental atmosphere will naturally lead to the next step, a further exploration of how the person is living in the world. In an in-depth relationship, any dependency upon a therapist should be expected to emerge, and be resolved.

This process is founded upon a relationship of trust and faith between therapist and client. It is a relationship based upon the idea that I, as a therapist, can guide a client to a more actualized life. This also implies faith in their own ability to achieve this. I’m not an expert in how they should live. Rather, I am an expert in supporting the inward searching process and the connecting dialogue. The client discovers their own rightness, and develops the skills to continue doing so after we finish seeing each other formally in the therapeutic setting.

Today many people are in therapy or considering it. There are many schools of therapy, each with its own set of values. People question the merits of various approaches, and some people question whether therapy is effective at all.

Twenty years of practice has taught me that therapy can be a profound and life-changing experience. I have been involved with many people who testify to the powerful benefits of therapy.

Yet with the many forms and styles which go under the heading of therapy or personal growth work, the choice of which approach is “best” is challenging for anybody. A few of the possibilities are long-term psychotherapy, brief counseling, peer counseling, group retreats, the supportive community, body work, and vision quests. Intense issues are present, as well as a certain level of vulnerability. Sometimes people will choose a combination of pathways to further their growth.

The important question to consider is not what is the “best” therapy, but what is best at this point in time. The challenge is not to pit one form of therapy or growth work against the other, but to consider them all as possibilities. Through research, feedback and opening to our internal sense, be it faint or dramatic, we will discover the next step.

To research, we can read articles and books, and interview professionals about their work. We can solicit feedback by talking with friends about the pathways they have pursued. Meditation/contemplation, as well as journal writing and other forms of creative self-expression are ways of connecting with our internal sense. The question we can ask of ourselves is “What am I most attracted to right now?”

In both choosing and undertaking a form of therapy, perhaps the most vital lesson is to learn to trust ourselves. This means growing to acknowledge that each decision we make is the right one, because it is the one we make. Trusting ourselves and the process will take us naturally to the next step on our journey. We learn to enjoy the journey, its ongoing mystery and discovery, exploring what it means to be human.

According to James Bugental, Ph.D., a noted Existential-Humanistic psychotherapist, as human beings we have certain capacities. These include the ability to choose, to act, to make meaning, to be in relationship and to be alone, to be limited, to be in a body and to be consciously aware. The existential perspective explores how we can be more alive and vital, and how we prevent this.

The work is accomplished through two simultaneous dialogues. One dialogue is with the internal self. Through this dialogue we learn to discover, connect with, and talk from the subjective center. We learn to open up to our internal life, our thoughts, feelings, images, bodily sensations, and whatever else is going on for us in the moment. This is an inward searching process, which is essential to changing one’s life. It is the way we come to truly know who we are. Knowing who we are is essential to impacting the world in a powerful way.

The second dialogue occurs between us and the external world, that is everything outside of ourselves. Through this dialogue we learn to live in objective reality. We learn our relation to others, how we impact and are effected by other human beings, nature, and society. Consciously relating to the world is essential to knowing who we are.

Through these two dialogues, the circle is complete. We come to know our inner core, the outer world, and the relationship between the two. The challenge is to make our two realities congruent – to match the outer world with our inner core. We have the power to consciously and continuously change both. As one reality is changed, the other is as well. Ultimately, we are beings in the world.


(c) Bob Edelstein. This article was published in the Spring 1994 edition of Reflections Quarterly Resource Directory