What do I know about therapy?

What do I know about therapy?

In my experience, people come to therapy because there is some kind of inner conflict between what they feel like and what they think they should feel like. Sometimes they externalize it in the form of a problem, such as, “should I divorce my wife?” But ultimately it is a kind of emotional pain, a dissonance between what they want to experience and what they are experiencing.

What happens, when it works well, is that they stop and take time to be reflective about themselves and what is really going on inside of them. In order to do this, they explain to the therapist what they think and feel. As they explain, they come to know themselves more deeply. They can only explain if they feel safe enough and not judged. So first of all, they try to figure out who the therapist is.

Over time, if the therapist can stick to taking care of the patient and not let his or her own needs get in the way, the patient begins to trust the therapist. That foundational trust in an external source of resources becomes solid enough that at some point, the relationship with the therapist is no longer in question. The therapist’s motives are no longer in question.

This is the trust that should have developed before age one. But we are a “crying in the crib” culture: our experience is that we will be abandoned if we have needs. So many people have not formed this solid internal structure of trust. They have held onto their relationships at the cost of not recognizing their own internal motives.

Once the patient has this kind of trust in the therapist, it does not mean that the patient never questions the therapist. It does not mean that the patient over-idealizes the therapist. It means that the patient trusts that the therapist, while fallible and human, can be relied upon to always be trying to do what is in the interests of the patient while they are together.

But the trust gets built. This takes a long long time. It is a very core structure, and it is overlaid by many years of compensation and coping. Patience is the most central necessity for this process to be allowed to unfold. The patient and the therapist must be able to think in the long, long term. It is a commitment to making the best possible life, not some temporary coping mechanism.

So first, there is trust in the therapist. After another little bit of time, this trust can be broadened to include a growing trust in the world. Not a naïve optimism, but an understanding that, given that each person is the center of his or her own universe, it is normal for people to try to benefit themselves. So people will let you down, and not everyone is reliable. But overall, the world at large is a resource-rich environment, and the patient can act to create a fulfilling life within that world.

Then, the patient begins to build a trust in him or herself. This is a real trust based on real life. And it is a trust that his or her deepest motives and ideals are acceptable and reliable and constructive. There is a depth of intimacy with oneself at this point.

This is the point at which many patients feel competent and confident about leaving treatment. And it is a glorious accomplishment. I believe, however, that there is just a little bit more to do. I have not really articulated this to any patients because I am just coming to understand it myself. I believe that the most difficult thing for people is to be simultaneously intimate with another person and autonomous themselves. It is my opinion that if the person stayed in therapy for a short bit at that point, they could discover how to create that experience in action: how you can be close to someone else and still be you.

About norasblog

I am a psychotherapist with a private practice in downtown Chicago.
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2 Responses to What do I know about therapy?

  1. Wow, fantastic to hear the perspective from a therapist- I keep being told ‘you must trust me’, but I believe that’s the wrong way round; that the therapist needs to show they are ‘trustable’.

    Really fascinated by your last point; I hear that you’re only just realising this aspect, but would be interested to hear more. What does the end of successful therapy look like (for both therapist and patient)? I’ve been trying to work out points on this one, theorising that it must be horrible to be a therapist because the final part of therapy (where the patient learns to be their own therapist, and thus realise themselves) can only happen once the door has closed; so as therapist you never get to see the finished product. What should a ‘goal of therapy’ look like?

  2. norasblog says:

    Yes, the therapist must BE trustworthy. Over and over again. With many missteps and repairs. Willing to accept the complexity and fuzziness of real relationships. In my experience, the end of therapy looks exactly like when children grow up and leave home. You do not miss anything. They stay in touch from time to time. They feel good. You both appreciate each other. They might stop in when they are working out something and want your perspective. The only thing that ends is the regularity of being together. The relationship remains.

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