A note on how psychotherapy works

(See also "Why psychotherapy" and "What’s the cure? What does psychotherapy do?")

Psychotherapy is rational and accessible. It is not some esoteric, undefinable, mystical process that only some people can grasp, a faith that only converts believe in and others do not. It is a logical process which anyone can understand and follow. There is no reason for anything in a session to be unreasonable or mysterious. On the contrary, in good psychotherapy every step should make complete sense to you, the patient; you may end up in strange territory, but it should be entirely clear to you how you got there. [George - II, Ed - II, Ron, Greg]

This notion that facts and logic drive the psychotherapy process goes a long way in countering the flood of abstract, even bizarre hypotheses that can clutter and confuse us when we try to think about what makes us tick. You may have heard yourself or others wondering "Maybe I sabotage myself", "Maybe I resent my wife", "Maybe I don't want to be the boss", "Maybe I'm afraid of commitment", "Maybe I need a vacation", "Maybe I'm the type of person who ...", "Maybe I'm a compulsive, an addict, a depressive, a type A, a type B, a ..." One can only answer, "maybe the sky turns green every time you stop looking at it"; the only way to know is to back up and look at the facts.

Facts are not only external, but include your feelings, your reactions, your perceptions. In sessions, it will be important for you to take an active role in trying on your and your therapist’s ideas. If he suggests that in your description of an argument with your wife you sound like a tantruming child who didn’t get his way, it is only you who can decide if that is indeed what you are doing. The most important proof that an interpretation or suggestion from either side of the room is correct is your reaction to it. And right or not, if you can’t benefit from it, it’s worthless.

Psychotherapy is a dialog. It is not a teaching session. You present data, the therapist offers ideas about that data, as well as his own data -- his feelings, his past experience, his own theories -- then you pick up the ball, and so on. Has the therapist helped you discover truth about yourself, your life, your feelings -- and is this material helping you make the changes you want -- or is he up a tree? If the latter, you must speak up. No therapist will be right all the time, of course, and it may be that your expectations for change are unrealistic or misguided. You have to sort this out together. But the final word is yours. Your therapist can tell you what’s probably going on with you, what seems to be happening, but it is only you who can say if he is right. Without your active testing of the material, psychotherapy degenerates into a thought experiment, a series of entertaining speculations and psychobabble that have no impact on your life, your behavior, your feelings.

Of course, it is up to your therapist to help you learn this active role. If you can’t understand how to do this and you are not getting clear guidance, it’s probably time to change therapists.

What Psychotherapy isn't

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