Why can psychological therapy be helpful?

Research explaining how therapy might help is filled with very technical terminology, e.g., invoking “transference”, “extinction”, heightening access to “cognitive–emotional structures and processes”, “reconfiguring intersubjective relationship networks” (see over here for more).

Could simpler explanations be provided? Here are some quick thoughts, inspired by literature, discussing with people, and engaging myself as a client in therapy:

  • You know the therapist is there to listen to you — they’re paid to do so — so there’s less need to worry about their thoughts and feelings. One can and is encouraged to talk at length about oneself. This can feel liberating whereas in other settings it might feel selfish or self-indulgent.
  • The therapist keeps track of topics within and across sessions. This can be important for recognising patterns and maintaining focus, whilst allowing time to tell stories, meandering around past experiences, to see where they lead.
  • The therapist has knowledge (e.g., through literature, supervisory meetings, and conversations with other clients) of a range of people who may have had similar feelings and experiences. So although we’re all unique, it can also be helpful to know that others have faced and survived similar struggles — especially if we learn what they tried and what helped.
  • Drawing on this knowledge, the therapist can conjecture what might be going on. This, perhaps, works best if the conjectures are courageous (so a step or two away from what the clients says) — and tentative, so it’s possible to disagree.
  • There can be an opportunity for practice, for instance of activities or conversations which are distressing. Practicing is a good way to learn.
  • Related, there’s a regular structure and progress monitoring (verbally, with a diary, or using questionnaires). Self-reflection becomes routine and constrained in time, like (this might be a bit crude but bear with me) a psychological analogue of flossing one’s teeth.
  • (Idea from Clare) “… daring to talk about things never spoken of before with someone who demonstrates compassion and acceptance; helpful because allows us to face things in ourselves that scare us and develop less harsh ways of responding to ourselves”
  • (added 27/10/2014) The therapist has more distance from situations having an impact on someone than friends might have so, e.g., alternative explanations for interpersonal disputes can more easily be provided.
  • (added 27/10/2014) It’s easier for a therapist to be courageous in interactions and suggestions than for a friend as — if all goes wrong — it’s easier for the client to drop out of the therapeutic relationship without long-term consequences (e.g., there’s no loss of friendship).
  • (added 15/01/2015) Telling your story to a therapist gives you an audience who is missing all of the context of your life. Most of the context can feel obvious, until you start to tell your story. Story telling requires explaining the context, making it explicit. For instance who are the people in your life? Why did you and others say and do the things they did? Perhaps this act of storytelling and making the context explicit also makes it easier to become aware of and find solutions.

Some thoughts…

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One comment

  1. Martha Pollard

    Interesting post, Andy, thank you. I got to thinking about the ‘they’re paid to do so’ aspect of what you wrote. I’m wondering whether the key part of ‘you know they’re there to listen to you’ is not the ‘being paid’ part; but the strength of the therapist’s sense of vocation to be a listener.

    In caring professions, it seems to me that where someone is there primarily because they’re paid to be, this may well lead to a very unfortunate therapeutic dynamic which is unlikely to be helpful to anyone, because resentment and bitterness could run through the whole process. However, when the listener is there because they feel that it is their vocation to be a listener, then that is likely to foster a trusting and helpful therapeutic dynamic. I’m thinking too of the many situations in which trained therapists/counsellors volunteer their services. The person going to see them still knows that the therapist is there to listen to them, and this will also be signalled by the therapist’s professionally empathic manner and listening skills.

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