What Psychotherapy Is, Can Be, and What It's Not

Whenever a first-time psychotherapy client begins with asking, "how does psychotherapy work?”, I start to wonder. Why are they putting a question about how I can help them ahead of telling me what they need help with. Of course I point that out and ask about it, and we launch into a discussion about their expectations, concerns, therapy’s usefulness, and possibly their own interpretation of what going to a psychotherapist means about them. I don’t mind answering the question. But my answer is limited. There isn’t one reliable answer. Every therapy experience is as unique as is every therapist/client relationship. But there are a few things that I can say about what therapy is, what therapy can be, and to clarify what therapy is not.

Therapy IS a relationship.

The two most important variables in psychotherapy are the client and the therapist. And just as is true in any relationship, therapist and client need to “click” with one another in order to have a relationship that will be the foundation for the work. So the first thing that therapy is, is a relationship built on trust and stability.

It’s a relationship that incorporates deep understanding, caring, conflict, and resolution. Those ingredients are critical in any important relationship. But the therapy relationship has one unique component. It’s one-sided.

A therapy relationship IS one-sided.

For most adults who haven’t been to a therapist before, coming to accept the fact that they get all of the support and have nothing emotionally expected of them, can be an awkward adjustment. And for those who are used to having a lot expected of them, it can then be a relief. It can also seem strange to pay someone for something so personal. The question often gets raised, “Does paying my therapist mean that they don’t really care about me? That they only act that way so that I’ll pay them?” The clear answer is NO. Your therapist got into this business because it’s in their blood to care about people. Caring about you is the raw material with which your therapist can work creatively with your therapy relationship, the way a sculptor works with clay. And how much you glean from that process depends on how much you participate. While the focus of attention is one-sided, the therapy process requires team effort.

Therapy CAN BE a variable experience.

Over the course of time in therapy, there may be periods that seem like you’re in a holding pattern. You might think nothing is happening, and other times when change is coming at you faster than you know what to do with it. And every variable of experience in between is also possible. Make the best possible use of your therapy by talking as openly to your therapist about your frustration, boredom, or anger with the process, as you do about your new insights and decisions to take action on them. Know that ebbs and flows are as much a part of therapy as they are a part of life.

Therapy CAN BE surprising!

If you knew what your therapy experience would be, you’d just do it. Without hiring a therapist. So neither you nor your therapist knows how your process will unfold. At some point you may realize that you'd expected it to be a certain way, and it’s turning out to be completely different. You may be surprised to discover that you’re therapist recognizes ways that you struggle, that even you didn’t realize. You may be surprised that your therapist doesn’t tell you to go home and do X..Y..Z. You may only realize that you had expectations, whey you notice those expectations are not getting met.

Therapy CAN include techniques and homework

Sometimes it makes sense to implement “tools of the trade” when those tools offer possibilities for discovery. Some therapy clients are interested in working a particular way, and will seek out a therapist who offers a technique, such as CBT, Hakomi, EFT, Hypnotherapy and countless others. But whether or not the technique brought therapist and client together, there will be times for using techniques and times for riding the wave of experience. In much the same way, homework may be given to stimulate a new experience outside of the therapy office. Your therapist just might say “go home and do X..Y..Z.  But even if a concrete homework assignment isn’t given, you’re doing your homework whenever you reflect on your therapy, and integrate what you’re learning into other areas of your life.

Therapy IS NOT one-size-fits-all.

Techniques come and go in popularity, or in what insurance companies will pay for. There are good reasons for the popularity, and for the insurance company endorsement. But your therapist needs to take your unique circumstance into account. CBT can be very effective, and insurance companies often want depression to be treated with CBT. But a particular person may not be a good candidate for that technique. Once again I say that therapists get into this business because it’s in our blood to care about people. Your therapist’s first job is to know and respond to the one-of-a-kind person that you are.

Therapy IS NOT easy answers to hard questions.

You may be expecting your first session to end with pearls of wisdom equal in value to the $200 you paid for the hour. But instead you just walk out scratching your head. Big change happens over time. Not with one $200 pearl of wisdom. With time, consistent sessions, and a willingness to use the feedback you get from your therapist, you have the best possible chance for the most lasting change.

So do you wonder if your concerns can be helped in psychotherapy? Your the only one who can answer that question. And the best way to research your answer is with your own personal experience. You can only know when you initiate your own life change by jumping in and discovering a new way to explore the one-of-a-kind person that you are.