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Sep 04

What IS Therapy, Anyway? Part 1

What goes on in a therapist’s office is a mystery to many who have never pursued psychotherapy. First-timers are often nervous and uncertain, not knowing what to expect. A common misconception is that therapy is some sort of cathartic, secular confessional, or that the therapist will magically “fix” the client—cure depression, anxiety, grief, social isolation, relationship and career difficulties.

Instead, a therapy session is more like a compassionate conversation. Regardless of the techniques or modality utilized, therapists work first to establish trust and rapport as a vehicle for getting to know the client through active listening. Since clients are the experts on themselves, the therapist’s role is to support clients in taking an honest look at their lives and the thoughts, feelings or issues that are getting in the way. The therapist is trying to determine how accurately clients perceive themselves and their world, how they operate in their lives—and where they might be getting stuck. Shame is often a roadblock and can become a powerful defense. Since people generally don’t see themselves as others see them, the therapist functions as a kind of gentle mirror for the client—a reality check. Over time, the therapeutic relationship itself can become a microcosm of how the client behaves with others in the larger world.

Some common goals I work toward with clients are pretty straightforward:
-becoming more honest with themselves and hence more self-aware
-getting to the root of their shame
-embracing their “true” or core selves
-reframing depression and anxiety as “wake-up calls” to address their emotional/spiritual immune system
-gaining insight into the various and often dysfunctional roles they play (and how they relate to the roles they played in their original families)
-challenging themselves in order to grow
-becoming more reciprocal in relationships
-developing or deepening empathy for others (learning to see things from others’ perspectives)

-learning to establish appropriate boundaries

-developing a clear voice in their own lives without bulldozing others
-practicing self-compassion

Christopher Peterson, author of A Primer in Positive Psychology, outlines similar tasks in regards to psychological health:

“-Acceptance of self
-Accurate perception of reality
-Autonomy (freedom from social pressure)
-Environmental mastery
-Growth, development, becoming
-Integration of personality”

It is important to note that addressing the aforementioned tasks is virtually impossible in isolation. Neuroscience bears out that it is the relationship between therapist and client that is especially critical in therapy—more important, according to several studies, than the modality used. Since our brains are “wired to connect,” having a trained and empathetic ear—a trusting relationship—is critical in clients’ motivation to make positive changes. This harkens back to Attachment Theory, which holds that our earliest attachments with parents or other loving caregivers provides the template for later relationships. For clients who have experienced compromised attachment, the therapeutic experience can serve as a sort of healing “re-parenting” or corrective emotional experience. To wit, human beings thrive in connection with others.

As clients gradually begin to trust, they can let down their guard and begin to shoulder personal responsibility for their own thoughts and actions. Blaming the world and others for their unhappiness or failures is as unproductive and misguided as taking on what is not theirs to bear. Therapists can help clients identify their strengths as well as self-defeating patterns, focusing of what they can control—themselves. And they can teach clients to forgive themselves and practice critical self-compassion.

Once they feel deeply seen and heard, once their shame has been addressed, clients can begin to heal themselves. The therapist essentially joins them on the journey and guides them in accessing their own, innate resilience.