Psychotherapy 101: Does Therapy Work?

One common thing that I hear from some clients or potential clients is that they’re unsure whether therapy actually “works.”  Sometimes the person wondering this is just skeptical.  Other times, they’ve already decided that therapy won’t do anything to help them, their relationships, or their family situation.  Other times, they’re skeptical but they remain open to the possibility that therapy could turn out to be useful.  The most challenging situation is when the person believes that, “nothing works.”  Though you might think that these three scenarios are basically the same thing, but they’re actually quite different.  So today I’m going to explain why therapy does work and how certain conditions in a person’s life greatly influences the usefulness and success of therapy.  But first, let’s identify and define what we mean when we use the word “therapy.”

Therapy isn’t a “Thing”

If you relate to the word therapy as though it’s a single thing, idea, or concept, this is mistaken.  It makes sense that you would relate to the idea of therapy in this way, but therapy is a very complex and organic process that evolves differently for each client.  Its foundation is based on two primary factors.  The first is based on the therapist and the other is based on you, the client.  The quality of the therapist, their training, their individual efforts to maintain a high level of proficiency (personally and professionally), and the therapy and theory that they utilize are huge factor in whether therapy is helpful or not.  However, therapy can’t do anything for a client unless they’re willing to talk about anything and everything.  Also, the client needs to be able to eventually identify which situations or aspects of their life that they would like to improve.  Next, they need to be willing to make changes in how they’re approaching their life on a daily basis.

As you can see, the foundations of therapy are not just based a single thing.  In fact, it’s dependent upon both people, not just the therapist.  Furthermore, the therapeutic process is typically very different for each person and it can be experienced differently depending on a number of other factors.  First, we all have different problems and personalities, so what’s done in a session with one person will be different compared to another.  What’s more is that if the sessions consist of multiple people or is in different kinds of settings (such as inpatient therapy or group therapy, etc.), the approach what happens in therapy will take on a different form.  And finally, therapy is often continued outside of sessions and this occurs when the client reflects upon what’s happened in therapy as they go about their daily lives.  If the client is not willing to continue the work and reflect upon things outside of their sessions, then there they probably won’t see much change.  However, when people make changes outside of therapy sessions, it’s not uncommon for the therapist to come up in their mind or even in conversations.  Many clients have told me how I’ve come up at home or that they think of me at certain moments in their life.  This happens for all clients and it means that therapy has become helpful and that the person is working.  The fact that they’re actually thinking about things as they’re doing them is a great sign.  Now, having considered all of these factors, we can now see just how silly it is to think of therapy as a simple thing.  To make this mental shortcut is about as helpful as saying that having kids is just the process of giving birth and feeding them until they move out.  All parents know that it’s so much more complicated!

“Just talking about stuff isn’t going to help anything.”

If you’ve thought this or said it, you’re right.  That’s why therapy is about talking AND taking action.  The therapist is there to support you as you decide what you’re going to change.  These changes involve behaviors, how you make meaning of events or experiences, how you experience and communicate your emotions, how you relate to your thoughts and emotions, how you problem-solve, etc.  The way that I work as a psychotherapist is that I support you as you determine how to move forward…or if you’ll move forward at all.  I might have a suggestion or an idea, but I’m never going to tell you that you have to do something.  It’s your call because it’s your life.  If you decide to keep doing the same thing and experiencing the same outcomes, that’s up to you.  And you won’t get any judgment from me.  Why?  Because your life is your life, and our therapeutic relationship consists of one or two hours of contact a week.  We’re not in each other’s lives and after all, these sessions are only about you.  They really have nothing to do with me or any other therapist.  However, talking, openly and honestly is necessary.

Talking is needed because this is how we uncover the things that have been influencing you for years and it helps us determine how things have come to be this way in your life.  We’re not raised or taught, for the most part, to be psychologically minded.  Meaning, the dominant culture in the U.S. doesn’t emphasize enhancing our self-awareness in order to identify our patterns of thinking, feeling, and behaving, especially at very deep levels.  Consequently, if you haven’t been in therapy or trained as a psychotherapist, there’s a 99.9% chance you’re not aware of everything.  Even psychotherapists have to develop and maintain this higher level of self-awareness in order to be of any use to their clients.  And higher degrees of self-awareness needs to be maintained, which means we have to do things to keep it higher.  It’s not enough to do a few things to enhance it, it takes some level of effort to maintain it.  Self-awareness, at a the deeper levels, requires consistent practice.  So, if you’ve concluded that you know everything about yourself and how you are, then this is your first obstacle.  If you continue to think this and enter therapy, then you’re not likely to benefit from therapy or change for the better until this defensive wall is weakened.  And yes, it is a defensive wall.  It’s okay that you have a wall up, you’re not a bad person for doing this, but it’s important to understand the purpose the wall serves.  When you’re willing to explore it and willing to consider taking it down, then therapy has the potential to be of use to you.

“Therapy doesn’t (or won’t) work for me.”

It might not seem like therapy can help, but this is probably because you’re not truly willing to do anything different in yourself or in your life.  And sometimes people will try something different, but if it doesn’t “fix” the problem right away, they give up immediately.  Change takes time, so we have to stick with it for a while to really test out our solutions.  Also, anyone can attend therapy sessions, for many weeks, and not see improvements in their life.  In fact, I can go to the gym and sit my butt on the stationary bike, but if I sit there and read without moving my body, should I expect to get healthier, skinnier or more muscular?  Of course not.  Therapy works in the same way.  If you’re a passive participant in therapy, not much will change.  Sure, there are times when you just need to vent and complain about something, but if that’s all you’re doing then not much is going to happen.  Also, if you’re not interested in gaining insight or identifying how you could change to make things better, things will continue as they have.  However, if you’ve never been in therapy and you’re saying that it doesn’t work, well that’s a different situation altogether.

When someone claims that therapy won’t be able to do anything for them, it’s usually a sign of fear or past resentments.  Somehow the person feels threatened by the fantasy of therapy.  And I use the word fantasy because any time we’re speculating about an experience that we’ve never had, it’s a fantasy or a fiction.  In fact, that’s all it can be.  Regardless, this negative view might be the result of the person’s sensitivities.  They may have been harshly criticized throughout their life and imagine that a therapy hour consists of them being told that they aren’t doing things right.  This can be an uncomfortable or downright upsetting thought for some of us.  It might reminds us, whether we’re aware of it or not, of some pretty intense memories.  Or maybe the person has felt constantly criticized by their partner or spouse and don’t feel like being ganged up on in a session.  These fears stop a lot of people from participating in therapy.  My suggestion is to give it a try, to give change a serious try, and then you can see for yourself.

Some Positive Accounts from My Therapy Clients

So far, we’ve talked about the negative views that we might have about therapy and how various factors figure into its success or failure for clients.  While these are important to remember, I’d like to end here by sharing a few stories about people who have really benefited from therapy.  The first one is my story.

When I was young, life was pretty difficult, family life was intense and tumultuous, and I was experiencing a great deal of anxiety and depression.  I entered therapy around the age of 10 and I continued for nearly 10 years.  Honestly, therapy helped me stay afloat and the older I got, the more I got out of therapy.  In the beginning, it was a safe place where I could talk about anything, say anything, and allow myself to feel what was really going on within me.  This, by itself, helped me so much because I didn’t really have a relationship where I could express freely and feel deeply understood.  As I got older and matured, I loved using therapy to gain more insight into myself, my life, and to figure out how the world worked.  The fact that I was using therapy was huge and I came into each session wanting to work on things.  As I gained more insight, I used therapy to help me figure out how I could change, and then I made those changes.  I never thought that therapy would make it so that my life wouldn’t ever have any problems, but what I learned was how to deal with problems, obstacles, relationships, and emotions in a much healthier way.  Today, I can honestly say that my life is much better off and contentment is something that I feel regularly.

A previous client that I worked with was middle-aged and had never been in therapy.  She was going through some pretty intense changes in life and her world was upside down.  She struggled over the course of a year with how to cope with all of the changes and she had to make some pretty big decisions.  Yet, therapy was a place for her to speak freely, be challenged to make changes when she felt stuck, and to decide what she wanted for her future.  Her other choice was to simply allow life happen to her, but she went another way. I learned several months after we stopped our sessions that she said that our time together was exactly what she needed, and that her life was so much better.

Another person that I worked with was having a lot of trouble in relationships, in herself, and with a career path that was rather stuck.  What’s more is that she was very afraid of being vulnerable.  Therefore, she had a very difficult time admitting to herself and others how she really felt, what she really thought, and how she lived.  There was a lot of shame going on and she was of the belief that she didn’t deserve much of anything good in this life.  Over the course of a year and a half, she pushed herself to disclose everything in our sessions.  This enabled us to work with what was really going on for her.  We would practice meditation together, and then we would come up with things that she could do to move herself in the right direction.  Most importantly, we worked to change her relationship to her thoughts and her emotions.  Instead of buying into them as though they were absolutely true, she came to learn where they had come from.  We gently challenged them and she came to realize that these thoughts were no longer helpful to her.  In fact, they held her back.  In the end, she grew to know herself inside and out, how her past had influenced her most basic assumptions about the world, and she knew how to challenge them so that she could ultimately do what was best for her.  The icing on the cake was that she found an amazing partner, and acquired a great new job.

What’s common in all of these stories is that the person made an effort to change and they were willing to explore what was really going on inside of them.  They were willing to figure out what they wanted, identify what they needed to do, and then they went outside of their comfort zone to do those things.  Sometimes it took them a bit to get there, but they eventually made changes.  And these changes were in how they thought about themselves, how they related to their thoughts and emotions, and how they took action in their life to get things moving in a different direction.  In my professional opinion, this is what’s needed for therapy to be effective.  Ultimately, therapy is a massive resource that can propel you forward…but you have to be willing to do the moving, regardless of the pace.  If you are willing, then change can happen quite quickly for you.

As always, drop me a note through my contact form if you’d like me to address a specific topic for you, and I wish all of you the best.


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