When patients enter therapy, their problems are usually deeper than they first appear. 2

from book Maybe You Should Talk to Someone: A Therapist, HER Therapist, and Our Lives Revealed

“So, tell me what brings you here today?”
That’s the question the author usually uses to begin her first therapy session with a patient. The answer the patient gives is called his presenting problem – the problem that brings him to the therapist’s office in search of a solution. It could be something specific, such as experiencing the loss of a loved one or suffering from panic attacks. Or it could be something vague, like a general sense of being “stuck.”
Unfortunately, a patient’s presenting problem usually isn’t his real, underlying problem – and the solution he seeks isn’t the real solution either. For example, a television scriptwriter named John came to the author with a seemingly straightforward set of presenting problems: he suffered from insomnia, fought with his wife and was feeling stressed out by work, where he thought all of his coworkers were “idiots.” To him, the solutions seemed similarly straightforward; he just wanted to be able to get a good night’s sleep and to vent to the author about his wife and colleagues.

But it turned out his real problems, along with their solutions, went much deeper. They involved some very tragic incidents from his past. When he was only six years old, his mother was run over by a car and died. Then, when he was an adult, he got into a car accident that killed his son; in a tragic coincidence, the boy was also only six years old at the time.

The combination of these two events led John to develop a host of personal and emotional problems, like unacknowledged grief and an inability to be vulnerable with people. Even in his therapy sessions with the author, he kept the tragedy of his son’s death a secret for nearly half a year, and he was unable to fully engage with the author. Instead, he deflected her questions with inappropriate jokes, insults, interruptions and other forms of rude behavior, including sending texts in the middle of therapy.

Acknowledging his grief and learning to become more vulnerable with people turned out to be the real solutions to his underlying problems. But it took him a lot of work to get to the point where he could even recognize these problems, let alone do anything about them. That’s true of most patients – even when they themselves are therapists. We’ll start looking at the reasons for this in the next blink.