PSYCHOTHERAPY – HOW IT WORKS

It takes guts to pick up the phone and make a therapy appointment.  Rarely does anyone decide to change until the pain they’re in is worse than the fear of the unknown.  That’s what it means to change – leaving the known of who I am and how I behave.  The familiar is safe even when it hurts.  For the therapy relationship to work, it’s important that counselors realize this.

Another hurdle to commencing therapy is asking for help. Most people don’t want to admit they need it.  To some, it’s a weakness or a failure. Our culture prides itself on self-sufficiency, independence and invulnerability. They don’t realize the strength in vulnerability and the power of surrender.

Seeking therapy also represents the beginning of trust in something other than one’s own resources. 

Giving up the pretense of “I’m managing just fine,” may be triggered by a crisis, an illness or a major loss, or progressive symptoms, such as anxiety, insomnia or depression.  Whatever the situation, it presents an opportunity when that person is teachable and willing to receive.  This in itself opens the psyche to the possibility of change.

Some individuals or couples enter psychotherapy with the idea of changing their partner, or they come because someone gave them an ultimatum.  They may be in denial about their pain and their contribution to it.  Some addicts only want to exam why they do what they do without giving up their addiction.  They are unaware that they indeed are suffering and that they have the power to change.  The initial period of counseling is about shifting the focus to themselves.

The most important factor in change is the relationship with the psychotherapist – more important that if the counselor is a psychologist, family therapist or social worker.  Just the therapist’s caring and active listening bring about change.   Several things are happening.  First, the individual is beginning to trust someone, meaning they feel safe enough to tell the truth.  It may be the first time he or she ever revealed their private thoughts to anyone, which builds self-esteem.  It is a statement of who I am.  “Someone is listening to me…I must be worthwhile.”  Moreover, just the act of talking about a problem affords some relief and gives a person a sense of objectivity and control over the situation.

Two other vital ingredients the therapist brings to the healing process are non-judgmental acceptance of the client’s feelings and thoughts, as well as accurate empathy, conveying to the client that he or she is really understood.  Consequently, it is important that the therapist not lecture, advise or judge the client, but instead try to see the world from the client’s point of view, and to let him or her know that you really “get” what it is like for them.  This makes it safe for the client to tell their story, and becomes the foundation for self-knowledge and, ultimately, self-love.

Self-esteem increases, feelings of shame are healed, clients trust themselves more, take greater risks in being authentic, and with each step build a stronger core of self.  In risking being who they are, in speaking their truth, clients are really learning to trust themselves and become more of who they are.  The need to please, achieve or look good dissolves, as increasing spontaneity and congruence between what the client says and does and how the client inwardly feels.

As a “relationship” develops between therapist and client, trust and rapport build, and the therapeutic relationship itself begins to play an important function in self-awareness and change.   It is a prototype of the client’s interactive behavior in all of his or her other relationships, particularly intimate ones.  Is the client being tentative, entertaining, manipulative, seductive, oppositional, or feeling judged, exploited, misunderstood, ashamed or abandoned?

Interestingly, the same actions of the therapist may have very different meanings to different clients.  The client’s view and interpretation of the therapist, called “transference,” discloses much about how the client sees the world and others in his or her life.  Take for example, a situation where the client is kept waiting a few minutes.  One client blames him or herself, thinking it was his or her mistake as to the appointment time; another client assumes the therapist forgot the appointment and feels abandoned; another feels jealous that the therapist is involved with someone else; while yet another is angry that he or she won’t get a full hour.

Finding links between the transference and the client’s relationship with his or her parents explains how their childhood still affects and often interferes with adult functioning.  Clients may discover that many of their patterns and beliefs are actually distortions of reality, which were developed at a time when clients believed their survival depended upon their parents and served to make sense of their childhood reality. When the therapist can present a different perspective and empathetically understand the client’s experience, those old wounds begin to heal.  Thus the therapy room becomes a laboratory to both examine the client’s feelings and behavior towards the therapist and others, and also is a safe place to try out new ways of being that are later tested in the world.

The client’s increasing self-awareness and introspection generates development of an observing ego, and gradually with awareness comes choice and a sense of mastery. As clients become more conscious of their attitudes and behavior, they are no longer as reactive and controlled by their habitual patterns

Therapy can hardly be considered a self-indulgent luxury.  It is certainly not for the feint-hearted, but requires tremendous courage.  Those who are committed to their growth and decide to weather the storm discover the joy and contentment of being free to be fully themselves. There is greater strength, resiliency and courage to risk, as well as genuine feelings of zest, passion, and joy for life.

Copyright, Darlene Lancer, 2008

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