How does therapy work?

Psychotherapy and counselling are sometimes viewed with suspicion as ‘just’ talking and therefore a little bit light-touch or woolly. People who are very practical or intellectual might therefore dismiss talking therapy before they even give it a go, i.e. “I’m not very good at talking” or “What good would talking about all these terrible things possibly do? I need help!”

In the way I work, a number of strands or approaches can come in, depending on a particular client:

• Exploration of what causes the current suffering – in addition to the problems that are in plain sight (i.e. "My boss is a bully and it's making me miserable") this might include exploration of childhood events and deeply held core beliefs. These core beliefs are often held unconsciously (so we’re not even aware of them), yet can be accessed in a skilled kind of conversation that psychotherapy is.
   
• Research shows that ‘witnessing,’ even if retrospectively (i.e. your therapist becomes a witness to something that happened to you a long time ago) can have a powerful healing effect. In combination with the therapist offering a different perspective or highlighting different aspects of the ‘story,’ witnessing can be impactful and transformative. Daniel Stern, a distinguished author in developmental psychology, speaks about the importance of a ‘narrative’ that gets created and even co-authored (by client and therapist together) in the process of therapy. Some of our narratives about who we are or what happened got set a long time ago and it can be liberating to realise that we have the power to literally re-tell our story.
   
• Difficult, unbearable emotions can gradually be experienced in the presence of a caring, attentive Other (the therapist). This may not be relevant to everyone, but is one of the key moments of change in psychotherapy. Wilfred Bion, an eminent psychoanalyst and researcher, speaks about the importance of ‘containing’ – the therapist will be there, very much affected by what you are saying and feeling, yet not overwhelmed by it – she/ he is able to ‘contain’ the difficult emotion. Research shows that being regularly held by this kind of emotionally sensitive but at the same time robust Other (the therapist) in time also helps the client to start to do the same for himself/ herself. And once we stop avoiding unbearable or difficult emotions and allow ourselves to feel them (in the presence of the Other) – they lose their power. The ideas of ‘containing’ are pertinent in the field of child development – the theory holds that it is the parent (or any other caregiver) who helps their baby and toddler regulate their emotions from day one. In psychoanalytic and psychotherapeutic research it is suggested that we are therefore already primed to be positively affected by the Other (parent or therapist): when the right conditions are met, healing can begin.
   
• In the psychotherapy literature (P. Casement 2014) it has been suggested that most clients arrive in therapy with a (more or less unconscious) hope that their needs could be met and that they could be truly seen. Simultaneously, many clients exist in a state of (a mostly unconscious) fear of retraumatisation. (Here we are talking about relational trauma.) Skilled psychotherapists are aware that to move forward in this landscape of hope and fear, one must be willing to take small risks. I often talk about the psychotherapy space as one where we can gradually try out a new way of being and relating.

As a result of the above, the following usually happens:

• New core beliefs emerge. This is usually a very organic process, sometimes seen more clearly in hindsight, i.e. at a review point in therapy. 
   
• As we feel validated, seen and heard without judgement, usually our sense of guilt and shame is significantly diminished. Our perspective broadens. There may be clear realisations, often felt in your whole being, not just intellectually, such as “It didn’t start with me,” “I am not faulty or broken,” "I have been doing X (perhaps a self-destructive or insensitive action) just to seek some happiness, which is a normal state for anyone to seek," etc. This in turn starts freeing up psychological bandwidth or energy to begin to make choices that are truly yours, coming from within. This is often a phase where self-help resources can be put into good use. Clients describe starting to value themselves, be kinder to themselves, starting to look after themselves more. Sometimes clients just describe feeling “more courageous,” “more settled,” “I’m aware the negative voice is still there somewhere but it’s lost its power,” etc.
   
• I have seen time and time again how a better relationship with ourselves leads to better relationships out in the world – with partners, children, friends, our own parents, colleagues, etc.