What is the goal of therapy?

Depending on who you ask, you’ll get different answers to this question. My guess is that most people would say something about change, and rightly so: learning to regulate their emotions, change unhealthy thought patterns, or improve their relationships, for example. Those are all important goals, and they are certainly a large part of good therapy. 

However, I want to propose another, related goal of therapy:

I believe that part of therapy is helping people come to terms with the parts of life that we cannot change or even fully understand.

Again, to emphasize, whenever we are able to change things in order to make them better, easier, or less painful, we should. If your relationship is struggling, talk to your partner, read a book, listen to a podcast, do some reflecting. And whenever we are able to make some kind of sense of what’s happening in and around us, then we should. With some good reflection and feedback, you may be able to understand more of why you keep getting angry over seemingly nothing. However, when we are not able to do either of those things, then we must find some way to cope, at least for now.

To me, that is both good news and bad (or at least difficult) news. On the one hand, there is often significantly more in our control than we initially think there is. With help from others, some creative thinking, and a little elbow grease, we are often able to make a significant impact on or around the things in life that are bringing us trouble, whether inside of us or around us. However, there is also much in life that is simply out of our control or makes no immediately apparent sense why it may be happening.

So, what should be the aim of therapy? I think it must be both. 

Marsha Linehan, the creator of Dialectical Behavioral Therapy, has this as her model’s core “dialectic” (a pair of things that at first seems in complete contradiction with one another that ultimately must be held together anyways): change and acceptance. 

Her advice is essentially the same as what I have written above–if you can change it, do so. But if not, then you must learn to accept it, and by doing so, you will actually alleviate some of the internal suffering you’re experiencing. She has an equation she uses, that “Pain + Nonacceptance = Suffering”, where “pain” is the unavoidable difficulties and challenges of life and “suffering” is the added, unnecessary distress caused by resisting the pain.

Now, there are some caveats that are worth mentioning. First, “acceptance” does not mean “approval” of the thing. It simply means that you’re acknowledging that it is there, and there is no going back in time to change it. Second, it doesn’t mean you should just roll over and take it and not try to enact some kind of change around it, even if it’s minimal. 

Acceptance means you’re saying, “This is here; this happened; maybe it won’t happen again, and maybe I can find some helpful ways to cope with it or change it moving forward, but the reality is that right now, in this moment, this is where we’re at.” Maybe it’s a difficult childhood you’re wrestling with, the ending of a relationship, or loss of a loved one. As you move towards accepting the reality of those things, you may find that you find some relief from their sting, even if it never fully goes away.

This is summed up well in the Serenity Prayer: 

“God, grant me the serenity 

to accept the things I can not change,

the courage to change the things I can,

and the wisdom to know the difference.” 

And this is what we will do in therapy. We will talk about and explore what’s troubling you. Whatever can be changed, we will seek to drum up the courage and the skills to change it. Whatever can not be changed, we will grieve and accept it. And in all of it, you won’t have to do it alone.