Michael Bader: How does psychotherapy work?
August 9, 2016
Lots of readers have either been in psychotherapy or know people who have.
Despite the different approaches that therapists have, there are a few things that are common to all approaches. Most therapies help people the same way.
First, most types of psychotherapy involve helping the client understand him or herself better.
They invite clients to notice what is going on inside them, as well as their habits of thinking and acting. The value of this technique is that understanding and insight help the person feel less controlled by feelings and thought-patterns and, instead, gain more mastery of them.
Naming something can provide some control over it. Some versions of insight involve understanding the past, while others, especially those influenced by mindfulness training, or those that offer what is called a cognitive-behavior orientation, emphasize understanding the here-and-now of mental life, including what the client is feeling in the room with the therapist.
The second pillar upon which most psychotherapeutic approaches rest involves either creating new experiences for the client or encouraging the latter to create them.
What I mean by this is that, whether the therapist does this intentionally, a good therapy usually makes it safe enough for a client to experiment with and experience a new and healthier way of relating to him or herself and the world.
Often, the first place this occurs is in the relationship with the therapist.
Over time, the therapist supports the client with experimenting with new behaviors in all of his or her relationships, providing help and evidence that healthier approaches to life are possible.
The hope that accompanies successfully changing behavior is crucial to many clients who come into therapy with the unspoken and pessimistic belief that the way things are is the way they have to be and are supposed to be.
New healthier experiences are a powerful way to disprove this cynical view of life.
For example, a woman I treated was afraid to ask her boss for a raise, even though she deserved one.
I helped her acquire insight into the belief she secretly harbored—and, because of earlier experiences, had always harbored—that she wasn't supposed to shine at work, that ambition was bad, and that she shouldn't promote herself and her abilities. Becoming aware of these beliefs and all of their manifestations was an eye-opener for her and helped her see how this inhibition was irrational and had held her back in many arenas.
As she felt safer with and more trusting of me, she began to experiment with being proud in our sessions about some of her achievements and then she gradually began to practice this self-assertion in other social arenas, finally getting up the courage to confront her boss with her legitimate claim to advancement.
This is how psychotherapy works. Other therapists might have approached her treatment differently, but, if successful, most all of them would have combined some sort of insight with some version of practicing new behavior, whether within or outside the therapy.
Insight and the experience of new healthier behavior is the key to psychological change and can be found in most psychotherapies.
If you're in such a therapy already, ask your therapist about it.
If you're not and want or need to be, ask prospective therapists where they stand on these two issues.
Michael Bader, DMH is a psychologist in private practice in Grass Valley. He an be reached at firstname.lastname@example.org
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