We Know More Than We Can Say

Written by Dr. Michael Milgraum on . Posted in Advice Columns

The most popular form of psychotherapy in the U.S. today is cognitive behavioral therapy (CBT). In this approach, the client and therapist define the problem area that needs improvement, identify the thoughts and behaviors that perpetuate the problem, and then develop a structured plan to alleviate the target problem or problems. One of the core methods in this approach is for the therapist to help the client see how his negative thinking is not only self-defeating, but also not rational. Then, the client can develop new types of “self-talk” that are healthier.

There is a substantial amount of research to indicate that the cognitive-behavioral approach is very helpful for a wide range of emotional disorders. Nonetheless, there are many conditions for which CBT is not particularly helpful and, in fact, may be counterproductive.

The cognitive-behavioral therapist may help the depressed client see that his exaggerated guilt or low self-esteem is not rational. However, the client often needs to spend time understanding the causes of these mental habits in order to make more fundamental changes in how they see themselves, others, and the world.

Conflicts within the family of origin, various traumas, and difficulty fulfilling roles assigned to a person often create a chronic state of emotional stress. The client generally has to look at and express these issues and the related emotional stress to the therapist before the client can enter into a new relationship with his own history. Insight-oriented therapies, such as psychoanalysis, excel at this type of therapeutic work.

Jacques Lacan, a French psychoanalyst who rose to prominence in the mid-20th century, had some important things to say about both the uses and limits of language in psychotherapy. Lacan believed that the words and phrases that make up our thoughts and a large part of our social world represent only a small sliver of the larger range of human experience. He posited that the goal of therapy is not to learn to say new and more helpful things to oneself and others, but to come to understand oneself in a more complete way, including the things that there are no words for.

Society teaches children, at a very young age, that there is a word or phrase to describe everything in their experience. This is all well and good as long as the child and, then, the developing adult does not come to believe that the words replace the original experiences. For example, the child might be taught that the feeling he experiences when his mother hugs him is called “love.” Nonetheless, that does not mean that if he says the words “my mother loves me” to himself that he will have the same feeling of reassurance as if she actually hugged him.

Lacan’s position was that societal demands for us to experience everything through language are so great that man perpetually experiences a degree of alienation from himself. Lacan said that this alienation is necessary to keep the social fabric in place and that a person must learn to live with the deprivations that come along with the advantages of living in a social world.

While I believe there is some merit to Lacan’s point about alienation, I think he overlooked the tremendous power of certain practices that can help us reconnect with and express those non-verbal aspects of ourselves. Music, visual art, dance, and the emotional expression involved in drama, as well as methods like meditation, give us an experience of those larger parts of us that really cannot be captured with words.

These days, children are often taught that when upset they should control their reactions and “use their words.” Although this is an important strategy, it is clear that “using our words” is not always a sufficient or effective solution. Children need to be taught not only how to speak out their feelings but how to draw them, sing them, and dance them to the full extent they may need to. Both children and adults need forms of creative, non-verbal and non-rational expression in their lives to remember that we are all so much more than just what we say.

By Dr. Michael Milgraum


Michael Milgraum is a psychologist practicing in Kensington, Maryland. He can be reached at (301) 980-3997 or This email address is being protected from spambots. You need JavaScript enabled to view it.