Chapter 1: The Quest for Diagnosis

I once had a patient who was consumed by the pursuit of identifying her own illness. Her dedication to uncovering her condition seemed to surpass mine in wanting her to find joy; while I aimed to help her discover happiness, she was fixated on discovering herself. She would guide me through her imagined diagnostic criteria, constructed from her own algorithms, searching desperately for a label to define her suffering. Each time we approached a potential diagnosis, she would shift her expectations, evading the recognition of her condition, much like a character in a fantasy tale who is never fully named.

Her conviction that something was inherently wrong with her was as puzzling to me as it was essential to her. She believed that if she could unearth this hidden ailment, it would justify her years of distress—an event that her true condition obstructed. Ironically, her fixation on finding a disease became her actual ailment, ensuring that she would never truly discover what she needed to confront: herself.

In couples therapy, the focus must be on the relationship itself. I evaluate whether both partners have greater faith in the potential for their relationship to thrive than in its likelihood to fail. This evaluation is less about the severity of their issues and more about the depth of their emotional pain compared to their memories of love. Often, the partner who is more emotionally injured insists that the relationship is flawed, even when signs of improvement appear, revealing defenses against love that must be addressed.

Some therapists believe it is their role to help clients cultivate belief in love over pain. Simply attending couples therapy can be seen as a commitment to the relationship and its resolution. This perspective holds true as long as the therapist prioritizes the needs of their clients over their own.

I often embody this role as a therapist—half the time. We all require someone to reaffirm our belief in love when we falter. However, I also acknowledge the unspoken truth: due to unresolved pain from past experiences, we can become more committed to identifying what is wrong than to affirming what is right. Many individuals enter relationships with unconscious self-sabotage mechanisms that activate with vulnerability. They become the hypochondriacs of love.

Hypochondriacs are known for switching therapists who inform them that they are well. With the rise of the Internet, hypochondria evolved, offering endless diagnoses and a plethora of therapists to cycle through until one finally concurs with their sought-after label. In this new landscape, therapists became accessible, interchangeable, and disposable—much like the ailments they were asked to diagnose.

I first recognized how well hypochondriasis aligns with teletherapy when platforms like BetterHelp emerged, resembling a dating app for therapy. Many users swiped through therapists not just to find a better fit but to reject any therapy that didn’t align with their personal agenda. This was no coincidence; therapists were even encouraged to post appealing profile pictures. As a result, many took it personally when patients abruptly ended therapy. I often encountered anxious posts from therapists lamenting, "What did I do wrong? My patient just left me!" It felt less like a professional consultation and more like the insecure individuals we were trained to be, questioning why we couldn’t convert healing into feeling valued.

While my experience with BetterHelp has been positive, the culture surrounding online dating and teletherapy shares a troubling overlap. Clients often replicate their patterns of dissatisfaction and abrupt terminations in their relationships with their therapists. Although BetterHelp had good intentions, teletherapy sometimes mirrored darker aspects of relational dynamics.

Consider the anglerfish: they encounter potential mates only once in their lifetimes. When they do, mating becomes an all-consuming affair. To anglerfish, promiscuity and lifelong fidelity are indistinguishable. Given their rarity of meeting new partners, they cling to their mates, with the male literally biting the female, never to release or move again. When she becomes fertile, he knows it because their bloodstreams are intertwined. He releases sperm in tandem with her eggs, effectively becoming her parasitic counterpart. Some female anglerfish even host multiple parasitic males.

Our couple therapist once suggested that polyamory is a healthy option. But what becomes of the males in this arrangement? They spend their immobile lives staring at one another, filled with insecurities about their chances of fertilizing her eggs.

Returning to our main discussion: I see in anglerfish a metaphor for codependency—a condition that reflects the struggle to find healing through another individual. In contrast, hypochondria embodies the search for a flaw within oneself.

In therapy sessions, I often express, "The only issue with you is your belief that there is something wrong." However, individuals cling to this notion for valid reasons: they are at war with themselves, undermining their relationships, and erecting barriers to love. Anyone engaging in this behavior does indeed have unresolved issues—failing to recognize that the true adversary often resides within, rather than in their partner.

They seek therapy to identify the real villain, and when the therapist reveals that they are, in fact, the antagonist, one of two outcomes typically occurs: either the therapeutic process can genuinely begin, or the patient reacts with anger and disappears, much like a fairy tale figure who vanishes once named.

Yet, my previous therapist insisted that my problems were entirely due to my parents! Hypochondriacs often believe that if they can identify their illness, it will vanish. However, once correctly diagnosed, they frequently withdraw. This reflects Jung's insight that individuals will go to great lengths, no matter how irrational, to avoid confronting their true selves.

If only the hypochondriac could embrace the belief that they are well, they might just be. This concept holds true for relationships as well. Many dysfunctions arise from the notion that the relationship is marred by abandonment, betrayal, conditional love, emotional unavailability, insecure attachment, codependence, or poor boundaries—mirroring the primary relationship from childhood. These beliefs manifest as behaviors projected onto partners or internalized by oneself. Regardless, they originate from unresolved pain that predates the relationship.

When we utilize our pain to discern what does not serve us, it becomes a valuable tool. We can then work to heal the relationship or decide to move on. Conversely, if we misapply our pain to form beliefs, it transforms into a parasite. Insisting that our relationships must mirror our childhood experiences is akin to the hypochondria of relationships: we endlessly search for past traumas in the present, seeking childhood experiences in our partnerships, or projecting parental figures onto our significant others. At times, we need to break unhealthy cycles; at other times, we may be the cycle itself.

A profound yet naive insight I’ve adopted in both couple sessions and my marriage is: What if everything is perfectly fine? What if this relationship is built upon two individuals who share the same goals but are struggling with how to achieve them? What if no one is trying to rehash childhood experiences? What if no one wishes to project parental figures onto their partner? What if this love is indeed safe?

What if we relinquished our belief that our relationship is ill?

This isn’t a call for bypassing or the superficial positivity that some life coaches mistakenly embrace as their vocation. Rather, it’s an invitation to release our preconceived notions of dysfunction, allowing us to cease recreating past pain through a self-fulfilling prophecy. Only then can we evaluate our relationship as it truly is, experience our pain in the present moment, and discover solutions for our actual suffering, rather than the suffering we inadvertently invited before even starting the relationship.

When my children were toddlers, they occasionally struck us. I would feel rage—a reflex stemming from my own childhood experiences, struggling not to repeat the patterns of my past. I tried to avoid believing that my child was failing me or that I was failing them, wasting years grappling with my own pain.

One day, one of my children hit my wife. She looked at our daughter and reassured her, "I am your mother. You don’t want to hurt me. You love me." They embraced for a lengthy moment, a powerful reminder of connection amidst chaos.

Also check out "The Drama Triangle Theory of Couple Counseling."