It’s Not the Protocol and Procedure, It’s the Person and the Process

So often we see measures of psychotherapy theories, methods, and interventions that seek to compare different techniques. We would like to know what is the best method. In reality, though, it is not the technique that creates the unique chemistry of a psychotherapy process but the persons of the therapist and the client. Education can help the therapist develop a deeper appreciation for what the client is experiencing; technique can provide ideas and ways of approaching situations; experience can add accumulated layers of similar interchanges. None of these can make the therapy work.

One hundred years ago, there was a very very wise woman who was one of the founders of social work in this country. Her name was Mary Richmond. She was not only smart, but also principled. Anyway, one of the things she said was that the effectiveness of social work, and of course of therapy in general, is based on the “effect of mind upon mind.” We can recognize this effect, even though we cannot measure it, and we cannot always predict how it is going to unfold. Constructive therapy is the result of the combinations of the unique persons in the room and the process of relating that transpires between them.

The difficult part is that it is not always clear what is working well and what is not. Sometimes the patient and the therapist disagree. Sometimes the patient leaves feeling worse than when he came in. Sometimes there is a lull and it feels like nothing is happening. The person who has the privileged view of the relationship is the patient. Therapists sometimes think they know more than the patient does. And it is true that therapists can see patterns of behavior and can reflect back to you what the therapist experiences of your relationship process. But the real expert is the patient. The trick is, we have to be reflective about what we are getting. It is not one meeting, and it is not the feelings that the meetings evoke that matter. What matters is, over the past 3 to 6 months, is my life better?

That “is my life better?” question really means, do I understand myself better? Can I regulate my actions and interactions a little better with this understanding? Do I have a better sense of who I am and what I want to do in my life? Am I a little less emotionally volatile? Do I get along better with the people I care about? Am I more focused or more satisfied in my work? The questions of therapy are different–less concrete, more existential–but nonetheless helpful.

A good therapist is not using a protocol on someone in the way that a physician has  a protocol for an illness. The therapist brings him or herself to the relationship, just in the same way that the patient does. We can use all the research, all the frameworks of understanding, and all the ways of relating we know about, but in the end, it is two people in a room, co-constructing a relationship that is a unique result of each person and which, it is hoped, will be of benefit to the person who is the focus of the time: the patient.

About norasblog

I am a psychotherapist with a private practice in downtown Chicago.
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