What is psychotherapy?
Psychotherapy is a form of treatment for mental health disorders and psychological problems. Patients or clients do not necessarily need to be diagnosed as clinically ill to gain from treatment. Because psychotherapy promotes personal development and growth though the reflection of personality, behavioural patterns and life experiences, anyone can reap benefits.
So how does psychotherapy work? If you ask one hundred psychotherapists this question you will get one hundred different answers. Much depends on the psychotherapist’s training, methodological orientation and posture (treatment philosophy). Although psychotherapy is often referred to as psychological therapy or talking therapy, it does not always imply that a patient will talk about their problem and symptoms to an expert who will diagnose the patient and then offer psychological advice (psychoeducation) which the patient may or may not choose to follow. In my understanding this form of treatment, which might be termed “psychological consultation”, differs in a number of respects to treatment via psychotherapy.
According to my treatment philosophy and way of working psychotherapy implies personal exploration, and developing emotional flexibility and growth through becoming a better (more adaptive) version of oneself.
Emotional adaptivity
Psychotherapy is about helping people to become more emotionally adaptive and flexible so that they can deal with external circumstances. Problems occur because people get stuck in unadaptive states. An example: a lady has a presenting complaint at the beginning of therapy that she is unhappy in her marriage and that she cannot leave her husband. She is angry at him and does not understand why she simply cannot leave him. With the help of therapy she begins to explore her emotions, the fear of losing him and being alone, the love she still has for him as well as the resentment and disappointment that have built up over the years.
As she works through this, she comes to realise that she is most afraid that she will have thrown away a large part of her life by clinging on to a marriage that cannot make her happy. She makes a promise to herself that she will put her happiness first for the next part of her life to come. As she starts to learn to put herself (instead of her marriage) first she gradually builds up the momentum to leave her husband with whom she has been so unhappy for so long.
Depth of Experiencing in Psychotherapy
Psychotherapy research tells us that depth of experiencing is important for change to happen in psychotherapy, where change is defined as a sense of being more satisfied with life and more able to deal with the challenges that one is facing. Depth of experiencing refers to the extent to which people are able to access their emotions and flexibility use them for guidance on how to interact with the world and the things that happen there. A low depth of experiencing is indicated when someone demonstrates a limited access to their emotional experience. Descriptions of events are factual, lacking feelings, sensory description and reflections of what is happening in the inside.
An example here of a narrative indicative of fairly low-level experiencing: “so the doctor diagnosed my mother with cancer last week, which was anything other than great. We are trying to find out what we can do about it but it is really difficult to get any information out of the doctors. That is the problem with the health system, there is never anyone there when you need them”. Now let’s look at an example of a high level of experiencing: “so the doctor diagnosed my mother with cancer last week, it came to me like a blow, as if someone had hit my really hard in the stomach. I really do not know how to deal with it. I guess I am just really afraid. I wanted someone to reassure me but no one seemed to be able to do that. I felt so alone.”
The first client knows that they are stuck, but they do not know what to do about it. The solutions they are looking for are not forthcoming in the places they are seeking, i.e. the doctors should solve the problem. Moreover getting hold of a doctor with information will be a quick fix but will not equip the client for their mother’s eventual death one day. The second client is talking about their sense of being afraid and alone. They are doing so in a way which shows that they are really connected with these feelings. When we connect to are emotions we can uncover and take care of the underlying needs driving these emotions, such as needs for safety, reassurance and comfort.
Building up the tolerance for emotions gradually
People cannot get in touch with their emotions for various reasons. One reason might be that they have never been taught to do it. We need to have the experience as children that our emotions are relevant and interesting for our parents and that they will be handled in a loving and empathic fashion that enables us to express and explore them further. If we experience disinterest, helplessness or sanctions when we show our feelings then we will most likely develop a tendency to hide them. Another reason might be because we are afraid of going Into those emotional places. Getting in touch with out fears and vulnerabilities can be really hard. It can be scary.
Psychotherapy should help people to gradually expand the limits of their experiences and not overwhelm them. In technical terms, we talk about people having a “window of tolerance” for their emotional experiences and this window must be gradually and gently enlarged through the process of psychotherapy. This particularly important where people have had very turbulent emotional experiences in life (e.g. trauma).
The important of relationships
Human beings are social animals. We cannot survive in this world without having contact and relationships to other human beings. Most of us also recognise an instinctive yearning for attachment and connection to significant others (partners, parents, children, and friends). Conversely we all have an instinctive fear of isolation, disconnection and losing significant others.
Pretty much all problems, symptoms and mental illnesses can be understood in this context. And if there are some that are not influenced by our connection with the rest of humanity I have not found them yet. An example here if what I mean: a man visited me some years back with depression, the reasons for which are not clear to him. He told me he loved his wife and four year old very much, and he had a job that was enjoyable and occasionally stressful but not enough to explain the existence of a depression. Now a depression is something that cannot exist at the same time as feelings of deep and secure connection. Depression is a state that implies that both our (biological) attachment and mobilisation systems our offline. It is a state of felt isolation and immobilisation. Through psychotherapy this man was helped to explore the ways in which he felt disconnected from his family even though he loved them very much and to address this. He learnt to access more of his emotional experience and to be able to share this with his wife and good friends. This led to a sense of others “having his back”, “feeling understood” and “having a place to go to work through his feelings” on difficult days.
Psychotherapy also implies for me, therefore, helping clients to explore the ways in which they form and take care of (important) relationships. This might mean looking at current relationships and and also reflecting about how important relationships (e.g. with parents, at school with peers, romantically) have formed the ways in which relationships are perceived and maintained. One way of doing this is by placing an emphasis on the psychotherapy relationship which should feel safe, supportive and holding and how clients react to the offer of such a relationship. Psychotherapy research appears to support this approach, suggesting that the chances for successful treatment are higher when the relationship between therapist and client is such that the client feels understood, validated and as such, held in positive regard by the therapist.
Psychotherapy should be experiential and relational
It follows from the research that psychotherapy should be experiential and relational.