Ask a room of graduate students what therapy is for and you will get some version of the same answer. Feeling better. Getting past it. Work through the problem. Ask them where that answer came from and the room goes quiet, because nobody handed it to them and nobody defended it. They absorbed it, the way you absorb the fact that meetings start on the hour.
I want to argue that this is a problem, and that it is a bigger problem than it looks.
My co-host on Got Therapy?, Dan Rose, put the general form of it this way in our most recent episode: anytime there is a cultural mandate for a certain emotion, there should be some necessary skepticism and some awareness of the conflict of that. Note that the claim is not about happiness. It is about mandates. Happiness is simply the emotion currently holding the office.
My own reaction, on air, was that nobody actually told us to be happy — and then, immediately, that maybe they did. That is the whole difficulty in two sentences. An instruction that arrives as an instruction can be examined, weighed, and declined. An instruction that arrives as an assumption cannot, because there is nothing standing there to argue with.
Where the assumption comes from
Dan's proposed mechanism is economic and unsentimental: within a capitalist system, the happy worker produces more. I do not think that is the whole story, and neither does he — when I pushed the framing toward its obvious political opposite, he declined the binary. But the direction of the pressure is worth sitting with. There is a great deal of institutional interest in people who are functioning cheerfully, and comparatively little in people who are accurately describing their circumstances.
What concerns me more, professionally, is the next step in his argument, which extends the same suspicion to a word we use a hundred times a week without inspecting it. Health. There are cultural mandates surrounding that concept too. A profession that adopts an unexamined definition of health inherits whatever the surrounding culture packed into it — including the quiet premise that improvement means feeling better in one particular direction, and that everything else on the chart is symptom.
We would never accept that reasoning if it were stated plainly in a treatment plan. We accept it constantly because it is never stated at all.
The measure I would rather use
Here is the alternative the episode arrived at, and I think it deserves to be taken seriously as an outcome standard and not merely as a nice image.
The crayon box has been Dan's analogy on the show for a while — a box of colours, each one an emotion, and a person's emotional life as a function of how many of them they can actually pick up. Dan drew the conclusion I had been circling: privileging any single crayon in the crayon box of emotions could be problematic. And the clinical aim that follows is not a redirection toward better feelings. It is opening a space where someone can colour with as many of those colours as possible.
Call the measure range.
By this standard, a course of therapy can succeed without the person ending up happier. What they end up with is granularity — the capacity to distinguish states they previously carried as one undifferentiated weight. And because emotions exist in part to signal, more distinguishable states means more available information, and more information means more actual choice.
I offered a phrase for this during the conversation and Dan seized on it faster than I expected: expanding the emotional field. What I like about it, on reflection, is that it names two things at once. It names range. And it names agency, because a person who can feel more of what is happening to them has more to work with, and more say in what they do next.
Compare that with a mandate, which does the opposite on both counts. A mandate reduces the number of feelings you are permitted to have, and therefore the number of things you are permitted to know.
What this asks of clinicians
Three things, none of them comfortable.
First, interrogate the goal. When a client arrives certain that the point of treatment is to stop feeling a particular way, that certainty is clinical material. It may be their own aim. It may be an instruction they have never examined. Finding out which takes about one question, and most of us do not ask it because the goal sounds so reasonable.
Second, stop treating ambivalence as a failure to answer. Depth of feeling is frequently made of mixture — Dan described a morning where joy and fear arrived together, and where the pleasure of an hour with his cat carried the knowledge that he will probably outlive him. That awareness did not cancel the joy. It coloured it. When we help someone resolve how they really feel, singular, we sometimes remove the very texture that made the experience deep.
Third, audit your own register. Dan said something on air that I wish more clinicians would say about themselves: I just don't think about thought that much. That is a limitation, he named it as his, and he did not disguise it as a theoretical position. Most of us have the mirror version of that asymmetry, and most of us present it as a method.
The part we could not finish
I will not pretend the episode solved this. I asked Dan for parameters — how does a clinician decide, in the moment, whether this is a cognitive question or an affective one? He agreed the parameters matter and that they belong in the book we are writing. Neither of us produced them. That question is still open, and I would rather leave it open in public than close it badly in private.
But the prior question is settled enough for me to state a position. Happiness is not a clinical outcome. It is a cultural preference that the profession has been treating as one. The outcome I want to be accountable for is whether the person leaves with more of the box available to them than they came in with.
That is a harder thing to put on an insurance form. It is also, I think, the thing we are actually for.
Michael Baltimore Ph.D. is Publisher and Editor-in-Chief of MIC LEDGER and co-host of Got Therapy? with Dan Rose Psy.D. This editorial draws on Episode 84, "The Happiness Mandate."