What is psychotherapy?

December 5, 2017

Psychotherapy is less mysterious than you think.  However, based on conversations I have had with a number of clients and friends, many people have an incorrect assumption about what psychotherapy is, or how the goals are achieved.  The most frequent assumption is that a psychotherapist is there to simply give opinions about your life, essentially telling you what to do to change it.  For example, a therapist might learn that you are in a bad relationship, and advise you to get out.  If this were the case, you would rightly wonder what you would need a therapist to do. The person in this scenario likely already knows that they are in a bad relationship.  What a therapist can do is help to clarify why the relationship is bad (it may not be only for the reasons you think), but also examine how the relationship is good.  More importantly, a therapist can help you decide what patterns/other relationships in your life exist that led you to the point of being in such a relationship.  Very few people, if any, consciously seek out bad relationships.  It either started out good and turned bad, or it started out bad in ways the participants could not see.

              Either way, in this example, the therapist exists to help provide some insight; in this case, into relationship patterns.  Advice might come up in a session, but it is likely to be about simply addressing the proverbial “elephant in the room”, i.e. making a statement that both the therapist and the client already know, but no one has verbalized it.  That said, insight on its own has limited value, and therein lies another part of psychotherapy:  working through it.  A client may say, “I know I need to do X, but how?”  That is part of the therapeutic process.  What happens when you try to do X?  What has happened when you tried to do X in the past?   A good therapist will have many variations on such questions designed to help you think, feel and act in ways you want to, but have not recently been able to do.  

              Another complaint I hear about psychotherapy is usually from people that have either engaged in it, or heard second-hand from another, and it is some variation on the following:  “I just sit and talk about my week, and that’s it”.  The implication is that therapy is just some regurgitation of the mundane details of life (“So, today I rode the bus, and…”) with no real revelations of any sort.  No one, client or therapist, wants to feel like nothing is getting accomplished.  But sometimes addressing the real emotions or thoughts that a client wants to address in therapy are too scary or undesirable to bring up, so defenses kick in, as they do in real life.  Defenses can be good, and are certainly natural.  There are times when the answer to “How are you doing?” is “fine”, even if you are feeling anything but fine.  A therapist’s job is to determine when to let you say “fine” and continue on, or when it is time to say, “I get the impression you’re not totally fine today”.  Much like a personal trainer, who takes feedback and experience to decide when there is too much or too little weight being lifted.

              I’ve also heard, though rarely, that people express a fear that the therapist is going to attempt to change the client into accepting their thoughts, values, etc.  In other words, be judgmental.  If you want a judgmental, directive, opinionated therapist, that is fine.  However, psychotherapy should not be a process of attempting to make a person more like the therapist, except when the agreed upon goal just happens to match a quality of the therapist.  Instead, a therapist should help the person be the best they can be, staying true to the most honest aspects of themselves.  You should not feel unfairly judged for who you are or who you have been; the work the two of you do toward change should feel like a change that you want to happen.  

              A psychotherapist should generally feel like a friendly, impartial, accepting guide that helps you grow as a person, and is able to use their training and experience to help you do so.  The therapeutic relationship should feel comfortable within a few sessions; however, if the relationship does not feel comfortable at any point, your therapist should be able to discuss it with you in a non-defensive manner.  Conversations like this can result in growth for both.  If you are willing to take the journey with your guide, and you take the time to find one with whom you are comfortable, the reward you may reap will be worth the effort.

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