How Do You Know You're Making Progress in Psychotherapy? Part II

In Part I, I explain four capacities indicative of progress in psychotherapy: tolerance for ambiguity, symbolization, imagination, and reflection. In this blog post, I'll continue exploring the capacities you build in therapy that signify psychological growth and emotional development, using Dr. Mark Winborn's list, Outcomes of (Psycho)analysis Central to Individuation. You'll start noticing that these capacities are intertwined. If you've noticed improvement in one capacity, you're likely also growing other capacities.  

5. Increased capacity for emotion regulation and impulse control

You've heard of emotion regulation and understand how important this capacity is in your life. If you let your emotions run wild without modulation, you likely won't be able to hold a steady job or maintain stable relationships. As necessary as this capacity is in life, sometimes you may not find it readily available. For example, you may know that acting out of your anger by becoming verbally or physically aggressive doesn't help you get what you want, running with your anxious thoughts intensifies your anxiety, or ruminating in hopelessness only leads to darker hopelessness and despair. Still, you have difficulties in tolerating these emotions without escalating them.

A main reason for these difficulties is that very few of us were taught emotion regulation/modulation skills growing up. Emotion education hasn't been part of parenting or our educational systems. It's rare for me to hear someone talk about receiving good guidance when they were upset as a child, like a curious inquiry from a caring adult, "Tell me what you feel anxious/worried/angry/sad about?"

More often, I hear horror stories of misguidance or even punishment from adults when a child needs help with emotion regulation: one person dealing with depression recounts being slapped in her face for "being selfish and stupid" when her told their mom about wanting to die in her teenage years; another person was beaten by his dad as a child person and smashes things impulsively when angry in his adult life; yet another person finds it challenging to self-soothe when feeling anxious, and they grew up under high expectations from their parents to "always do the right thing."

You're not alone if you find it difficult to regulate/modulate your emotions and control your impulses to act out of your emotions. A therapeutic space is created specifically to help you build these muscles. Different therapists may disagree on how to help their patients, but this capacity is emphasized across all forms of psychotherapy.

6. Increased capacity to maintain cohesion of the self during periods of emotional intensity

"Cohesion of the self" can be understood as an intact sense of self, out of which you recognize qualities of who you are (i.e. "I'm happy, loving, generous, sensitive, funny, complex...") and what matters to you in life (i.e. "I want to make meaningful connections," "I want to achieve goals and feel competent," "I want to understand myself," "I want to impact others," "I want to discover and enjoy beauty in life...”)

Your sense of self needs cultivation and consolidation in time. None of us was born knowing who we are and what's important to us. Through our caregivers' recognition and guidance in our early years at home, through socializing with peers in schools and communities, and through forming significant relationships in adulthood, we discover more and more about ourselves and what we value.

If early recognition, guidance, nurturing, and socialization aren't in place, your sense of self becomes like sand castles on the beach, with no solid foundation to stand on, easily washed away by waves of intense feelings. For example, under significant stress, someone who is intellectually capable and good at their job starts feeling like a failure and becomes hopeless, resulting in poor job performance; someone who cares about their friends acts out of anger, says hurtful things they later regret and hurt their friendships; someone who values empathy becomes cold and indifferent and cuts people off when they feel rejected by others...

Winnicott's (1960) concept of false self is helpful here. The false self is like a mask you put on when you don't feel understood and accepted, so you show up as someone you think are more acceptable (i.e. "I'd be loved if I don't talk back and just listen," "people will accept me if I take care of them...”) Sometimes, you wear the masks for so long that you think the masks are who you truly are, even though you feel confused and empty deeper down. A good therapist puts understanding you and recognizing who you are before anything else, and through their understanding and recognition, you'll learn to see through your mask, recognize what is true about you, and start taking off the masks, which allows for fewer mental and emotional issues, and more authentic living and satisfying relationships.

Your emotional life is like your personal dragon: unique, powerful, and vital. When you run away from it, fight against it, or avoid it altogether, it becomes scary, destructive, and overpowering. When you face it, connect with it, befriend it, you become empowered, with clearer directions and expanded capacity to explore your world, internal and external.

7. Increased capacity to delay gratification

While acting spontaneously isn't a problem in itself, when there's a pattern to act for instant gratification without forethought about the consequences of your actions, you'll likely find yourself in undesirable situations and feeling guilt and regret later on. For example, impulsive shopping can lead to overspending and financial difficulties; impulsive eating can lead to health problems; and yelling at your loved ones can hurt your relationships.

In therapy, you learn to create a space between your impulses and actions. In this space, you hold yourself in your mind for a moment when you have impulses, letting thoughts of consequences arise and register. I've heard people talk about hearing my voice in their heads or remembering a conversation from a previous session when they're about to act impulsively, which helps remind them to give their impulses a second thought — this is an example of what the space between your impulses and actions might look like.

8. Increased capacity for emotional resilience in the face of adversity

Difficulties in life—losses, illness, conflicts, hurt, betrayal, stressors—test our characters. The outcomes of these tests are determined by your emotional and psychological capacities, which therapy is designed to help you cultivate.

While your emotions may run wild when you face life's adversities, in therapy, you have the opportunity to learn to contain, relate to, and be enlivened by them. I think of this as training your dragon. Remember how wild and unruly Toothless is in the movie How to Train Your Dragon? With empathy, patience, thoughtfulness, and practice, Hiccup befriends Toothless and rides on Toothless's back to reach a wider world and embark on heroic adventures. With therapy done right, you learn to befriend your emotions, experience a wider range of them, expand your capacity to face your life difficulties, and find meaning in them.

I'll stop here today and explore more capacities you can develop in therapy in upcoming blog posts. Stay tuned! If you want to start building these mental and emotional muscles, here's how to find me.

References:

Winborn, M. (n.d.). Outcomes of Analysis Central to Individuation [PowerPoint slides]. Inter-Regional Society of Jungian Analysts.

Winnicott, D. W. (1960). Ego distortion in terms of true and false self. In D. W. Winnicott, The maturational processes and the facilitating environment: Studies in the theory of emotional development (pp. 140–152). Hogarth Press.