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Therapies disagree loudly about method while quietly running the same underlying process.

Every therapy regulates uncertainty, but the skill that does it is unnamed and so untrained.

The clinician's own mind is the instrument—foggy, uncalibrated, rarely examined as one.

In one consulting room, a patient is learning to notice a distressing thought, name it, and set it down—to stop rewarding it, so that the feeling has somewhere to go—while perhaps a few doors down, another patient is being told that the troubling thought is important to pay attention to, that growth is challenging, or perhaps even that pain in some way is good, and that avoiding such thoughts is how a person stays stuck. Another therapy provider might just wonder about the presence of such thoughts, or even ask, "What if you did, and what if you didn't?" Another might give a worksheet to take home on such thoughts. Another might recommend processing right then and there. Every one of them is competent, every one working from evidence, and each could give you a reasonable account of when one of the others would be the better choice. To boot, not all schools of therapy recognize the validity of some others.

Therapies that help people exclude negative thoughts and feelings to regulate emotion may delay, or in some cases preclude, processing those experiences—learning from them, maturing through them. Therapies that press processing run the converse risk: that the pressing exceeds a tolerance threshold for the particular individual doing the processing. Between those two failure modes, the alternatives are nearly infinite, effectively, within a tightly constrained possibility space of what is considered to be therapy (Brenner, 2009).

The Beasts in the Consulting Room

No one agrees on what therapy is. We don't even agree on what it isn't! There are pockets of agreement and areas of sharp disagreement, and the schools are divided both externally and internally. One might think of the proverbial blind men and the elephant, each groping around and feeling a different part of the animal, each concluding that their own small sample was the whole.........

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