What changes in psychotherapy?

By Mark Epstein, MD.
It is a paradox of therapy that although impermanence is one of the fundamental laws of the universe, most people do not want to change. They hold fast to their ideas of themselves, to their interpretations of how things are, to their grievances, their anxieties, their identities, and their pain.
Fear in life is fear of change, John Cage said, in one of his most famous pronouncements. His lifelong friend, the artist Robert Rauschenberg, often repeated Cage’s aphorism, adding his own coda: “Nothing can avoid changing. It’s the only thing you can count on. Because life doesn’t have any other possibility, everyone can be measured by his adaptability to change.”
That is one way to phrase it, I thought. What changes in a successful therapy is one’s adaptability to change. In many ways, just saying this much might be enough.
In the case of therapy, if you’re lucky you stop taking your gripes, your feelings of injustice, and your insecurities as seriously as you did when you began. This relaxation allows a more flexible and realistic attitude toward everything. It permits the self to adapt to the change that it is intrinsically part of, rather than trying to hold itself apart. And it permits a natural compassion to arise, both toward yourself, caught in whatever you still get caught in, and toward others, caught in their own pain.
There is a thread that connects the worlds of therapy and meditation, a thread pioneered by the British psychoanalyst D.W. Winnicott. To Winnicott, the very basis of human nature is a fundamental state of “essential aloneness” that paradoxically exists only “under maximum conditions of dependence.” The psychoanalyst Michael Eigen calls this the “boundless, unknown support” of primary aloneness. “It seems to me,” Eigen writes, “that something like a sense of a boundless unknown is part of the background sense of existence. It provides a basis for a sense of emergent trust and faith. If [we] cannot trust the environment to uphold our beings, we live in jeopardy.” This sense of background support is what a successful therapy makes possible. Its emergence helps make the inevitable changes of life more tolerable, allowing suffering to be acknowledged and clinging observed with something akin to humor.
Mark Epstein, MD, is a psychiatrist. His most recent book is The Trauma of Everyday Life: A Guide to Inner Peace, published by Penguin Press in August 2013