Many people enter therapy because their day-to-day life has become disrupted by symptoms: for example, obsessions, compulsions, anxiety, depression, problematic relationships as well as chronic states of confusion, resentment, rage and despair.
What is a symptom?
We are probably all familiar with medical symptoms. They usually appear on the surface of our body and are a sign of an infection or some other illness.
For example, a high fever, cough, runny nose, red and watery eyes, along with a rash are probably symptoms we have the measles virus.
There’s a cause-and-effect relationship which we can picture as follows
measles virus in body ⟹ symptoms on surface of body
The symptoms with which therapists work are different, however. We can think of many therapy symptoms as representing a compromise between powerful internal forces pushing in different directions at the same time.
Force 1 ⟹ symptom forms as a compromise ⟸ Force 2
It is a little like the couple who argue over whether to spend their weekend break in a city or at a beach resort and then settle on the countryside as a compromise.
So symptoms in therapy are protective or defensive compromises, a sign that we are somehow ‘out of sync’ with ourselves.
We can imagine a situation in which Force 1 and Force 2 can be equally matched and somehow cancel each other out.
The compromise might be we are left with very little or no energy, since all our energy is tied up in this struggle.
So the symptoms might include our finding it hard to get out of bed in the morning, or a loss of concentration and purpose, or a loss of sex drive, or a depressed feeling.
symptoms in therapy often represent a compromise
Of course, the forces may not be equally matched and one may gain the upper hand in the compromise.
So always forgetting your wedding anniversary despite your best intentions, or getting into the same argument over and over again, or needing to check repeatedly your front door is locked. All these may be symptoms in the therapy sense.
People often turn to therapy not because they have a symptom but because their symptom has become too disruptive, or has come to be maintained at too high a price.
The first task of therapy is not to remove the symptom but to look at its cause – that is, the conflict that is giving rise to the symptom in the first place.
A work of art
A picture by the British artist David Hockney can help us to think a bit more about symptoms in therapy.
This picture came about after a friend, Henry Geldzahler, approached Hockney to make an original art work for him to sell for charity. Geldzahler recalled their conversation,
Hockney said, “Let me do a portrait of you” and I said “You really can’t because I am fund-raising for them. It would look a little funny.” So he said, “Well”, and just sat down… and in about an hour, he did my jacket, my hat, my pipe and my iced coffee. I like that picture because it’s a portrait of a subject with the subject missing.
We can think of the picture as a compromise between two forces: Hockney wishing to produce a portrait of Geldzahler but not being allowed to because Geldzahler was the fund-raiser.
So a compromise was reached: the picture is a portrait though one with the subject missing!
symptoms in therapy often seem nonsensical
This alerts us to another aspect of symptoms in therapy.
Symptoms often seem to be nonsensical: like having to check the door is locked not once but many times, or flying into a rage over what seem in retrospect to be trivial matters.
It is as though the subject is missing or disguised, just as the subject in Hockney’s picture has been disguised.
A psychotherapist is trained to understand symptoms – your suffering, your complaint – as a compromise that represents something intimate, important but only half-expressed.
The measles infographic is taken from the Centers for Disease Control and Prevention (accessed June 2019)
The idea of using opposing arrows as a way of making sense of symptoms is taken from the first chapter of Bruce Fink’s clear and accessible book, A Clinical Introduction to Freud, 2019.
Henry Geldzahler recalls his conversation with Hockney in, ‘Hockney Abroad: A Slideshow,’ an article published in the periodical Art in America, February 1981. For further reading on Hockney’s use of metonymy see chapter four of my book written with Ulrich Luckhardt, David Hockney Paintings, Prestel 1994.