Maybe You Should Talk to Someone

Lesson 1. A Presenting Problem Conceals The Real Problem.

The initial complication that drives a person to the therapist’s door, seeking for help, is called the “presenting problem”. It could be a number of things - prolonged depressive episodes, panic attacks, loss of loved ones, job loss, death or even sometimes a suffocating feeling of being stuck. A presenting problem could be anything which motivates a person to begin therapy. However, a patient’s presenting problem is usually one aspect of a larger, more complex problem. It is just the tip of the iceberg rather than the iceberg itself. For instance, when Lori herself had started seeing a therapist, Wendell, she made it clear that she was there for some crisis management. She had been through a sudden, shocking break-up and needed help to get over it. But that's just her “presenting problem” and a temporary solution that she was aiming at. The real problem was buried far deeper and it took a lot of time for Wendell to help her unearth it. And when the real problem surfaced, she realized that it was a lot larger than the presenting problem at hand. Her fear of the metaphorical death of her relation as well as the literal death, her mortality, had been tormenting her.

Also there are times, when the presenting problem has nothing to do with the real, underlying problem at all. For example, John, a middle aged TV scriptwriter, came to Lori to seek help because he was annoyed with everyone around him. He felt that everyone around him were “idiots”. He also had issues with his wife and couldn’t sleep. It took an enormous amount of time for him to recognize the actual problem which was far removed from the presenting problem. It was the grief of losing his loved ones and a deep sense of isolation that affected him deeply . 

Despite being just a camouflage, it is the presenting problem that does the job of getting a person through the door to therapy. However, it might take a longer and more circuitous route to get to the real problem, let alone the solution. Infact, the therapist is the one who dives into the depth of a patient’s problems and helps them discover the cause of their real  problem.

Lesson 2. Patients Tend To Deny Responsibility Of Their Own Predicaments.

At the beginning of a therapy session, a patient usually comes with the presenting problem and a self-constructed narrative wound around it. This narrative is a rather unhelpful one. It is something a patient builds to simplify the real cause that drives them to therapy.