Therapy is Like Peeling an Onion
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Therapy is Like Peeling an Onion

Clients come to a clinician’s office with what is called a presenting problem. More often than not the presenting problem is not the whole picture. The presenting problem is usually a symptom of an underlying cause the client may not even be aware of; but the psychologist, psychiatrist, or counselor must get to the bottom of.

In therapy the clients will always come to the psychologist or counselor with what is called a presenting problem.  This is the reason they believe is causing the problem but rarely it is.  Therapy is the process of getting beyond the original complaint and digging deeper to find out if there are more reasons even more significant than the presenting problem.  Psychologists often use the analogy of peeling an onion to get through the various layers and get at the root of the problem.

For example, a person may come into therapy stating that they have trouble making decisions and they don’t know why they have trouble making decisions.  No one would argue that this is not a great reason to seek help.  However, decision making may simply be a symptom of a greater problem the client is not aware of.  A child that is fed a diet of negative comments from their loved ones my lack self-confidence and self -respect.  Imagine being told all your life that you are stupid, you don’t run your life the way you should, and you can’t choose the right man or even the right pair of shoes without somebody’s help.  Wouldn’t that make you feel you couldn’t make good decisions?

If you feel you cannot make good decisions or you will not feel very good about yourself.  Not feeling very good about your self is a layer in the onion.  Then the next layer is a layer of depression.  Not being able to make decisions could hamper a person’s life.  It could get them in trouble for making the wrong decisions, meaning this layer is about rash decisions not thought through. 

Again,  even this is simply another layer because the question becomes why would clients do that?  A psychologist or counselor must dig deeper to find out why.  One example that comes to mind is a clients who has been indulged all their lives and got whatever they wanted from their parents, never had to make decisions; they just asked and was given everything they wanted without ever having to think about it. .  Now as adults they make a decision such as to charge items on their credit card without thinking about do they really need this new expensive outfit or can they really afford it in the first?

Trouble making decisions could take on the opposite behavior where the person takes so long to make a decision that the situation at hand gets worse, Imagine an abused woman who does not making the decision to leave and is then killed by him.

Another scenario could be that the decision was made, but the opportunity was missed.  Here imagine a person who was offered a really good job but by the time they got back to the employer the job was already taken.  How many times have we all heard if you only got back to me sooner, I sold the car yesterday, or I hired someone last week and so on.

The real therapy begins when the onion is completely peeled and all the dots are connected.  Depression is often the reason for lack of decision making ability and that stems from lack of confidence, feelings of  hopeless and uselessness, feeling we are incapable of making good decisions because we get them wrong and so on.  You would be surprised how many people do not even realize they are depressed and will come up with other excuses for their behavior.  Or, defend,” I am not depressed I just can’t seem to make good decisions.”

In conclusion I am not saying depression is the only reason people cannot make decisions, but it is one of the key factors often involved when peeling the onion.


Training as a therapist

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Comments (4)

Yes I have always thought of it as peeling an onion. We go through layers and layers to get to the core.

Ranked #2 in Psychology


Excellent and interesting information. Well presented, as usual, Carol. Have a great weekend!

Ranked #2 in Psychology

thanks Bethany