How Do We Know Psychotherapy Helps?
/My graduate school teacher once asked our class to consider how it is that we know that our work actually helps our clients?
“If you’re warm and loving and your client really likes you, is that necessarily helpful in resolving their issues?” It’s an important question. The question reflects a common misconception that therapy is about getting sympathy to feel better, but doesn’t really change anything.
Coming to therapy for the first time, people often ask “how is this supposed to work?” They want to know what my plan is, because I’m supposed to be the expert. They want to prepare themselves for something they don’t yet understand. The tricky part is, that I can’t fully satisfy their desire to know what’s going to happen. I can’t possibly predict what’s going to happen for this unique person in their singular situation. One thing that’s clear is the discomfort that motivated that first phone call. That’s a landmark from which to start our exploration.
“If I’d asked my customers what they wanted, they’d have said a faster horse.”
Whether or not we think that we know what the difficulty is doesn’t really matter. Even with a logical explanation of the difficulty we’re still left thinking, “I should be able to get myself out of this”. But it isn’t always such a straight forward process. Figuring things out isn’t always the satisfying solution we expect it to be. Therapy is special in that it allows for things to not make sense.
As our work progresses there might be some clear signs of progress. Behaviors may change in a way that feels better. That’s wonderful. But we want it to last. Real change happens from the inside. This is why it’s so very important that sessions happen consistently, even after things appear to be better on the outside. I haven’t really helped my client if, when they stop seeing me, the problem resurfaces.
Integration
A model of how we acquire any new skill was developed by Noel Burch at Gordon Training International. The model proposes that there are four psychological stages to learning:
Unconscious Incompetence: Or not knowing what it is you don’t yet know. Ignorance is bliss…. Until it’s not blissful any more and simply can’t be ignored. An old saying goes: “the phone keeps ringing till somebody answers.” It’s a saying that predates voicemail, but works on a psychological level. The phone is a metaphor for that nagging sense that something is just not right.
Conscious Incompetence: Which is the most painful stage, and often a motivator for seeking out counseling. Sometimes in therapy we notice that the pain becomes greater before they get better. This can look like becoming aware of something that was bothering you on an unconscious level. Making it conscious never feels particularly good. And it doesn’t need to last long.
Conscious Competence can feel like the breakthrough you’ve been waiting for. And it’s tempting to terminate therapy, because they feel like they have what they came for. But a new level of consciousness can open the door to another level of unconsciousness. And so we find ourselves back at unconscious or conscious Incompetence. And sometimes they do stop coming at one of these intermediary levels. But my hope is to have people leave after they’ve reached the fourth stage.
Unconscious Competence: This is the stage where we get to see an olympic gymnast perform. They’d never get through their program if they needed to be conscious of every move they make across the mat. They don’t think about each element of how to execute a tumble. When the tumble needs to happen, a tumble happens.
I know that I’ve helped my client when they are demonstrating their new competence with the unconscious grace of an olympic gymnast. I know that change has happened from the inside, when the elements of their life that have gotten stuck in the past, now flow with unconscious grace.