How therapy works

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I have a few new clients lately and they have impressed me with their savvy. More than one has expressed something along the lines of “understanding won’t bring about change - I don’t just want to dredge up the past for nothing.” These words could mean a lot of different things. It is of course completely particular to each person. I hear two things in particular that I want to focus on in this post: (1) I don’t just want to talk, and (2) I am afraid of the pain that is lurking beneath the surface and I am afraid to feel that pain.

Their comments have me thinking about change in therapy.

In the past I have written about the cognitive piece and the emotional piece in therapy and I as I sort through my thoughts here I realize there is more I’d like to say.

It isn’t that there is a cognitive piece and an emotional piece. Every thought comes from a person. A person with a body. Every thought is an experience. A bodily one. So it’s all one piece.

Some people come to therapy having never talked with another person about themselves. In therapy they learn to formulate an expression of their experience. For example, “I was hurt when my mother did X.” For them, these expressions are entirely new and as such are agents of change. By having the thought, expressing it, and having it met with an empathic response, the world of the client changes bit by bit.

Clients who come in already “knowing the causes of their problems” are rightly resistant to going over this material again. It isn’t new. So it is just talking. While still embodied, for this client to say “I was hurt when my mother did X” doesn’t get them any further than telling me, “I graduated from UWO in 1993.”

What we’re after is not actually understanding but experience. With the first client it looks like they are gaining understanding. And this is certainly a side benefit of much therapeutic work. But what they are really having is an experience. An experience of having a feeling, putting it into words and having it received by another person. And this is what the more self-aware client also needs. But not about the “old stuff”. They need to begin to articulate “new stuff”.

So how does this happen? To take a phrase from one of my teachers, the client needs to bring a “duty of honesty” to therapy. This means that you, the client, commit to speaking in detail and often about everything that is happening for you. I don’t mean telling endless stories ‘about things'. I mean speaking about your experience - your experience in the world and your experience in the therapy room. Your thoughts, feelings, fantasies, dreams, curiosities… you need to bring yourself to the room.

This can be as ‘little’ as your irritation at the dumb magazines in the waiting room, or the butterflies you feel in your stomach when you look in the mirror. You don’t need to understand the meaning, either. You don’t even need to try to understand the meaning. Just bring yourself.

And together as we follow the trails of your experience we are following the breadcrumbs that help us to find who and what we need to find.

We don’t know what is at the end of the path. By definition we do not know. But we know there is a path. And if we can follow the path with faith our work will bear fruit.

Faith is a topic for another post. Another word for faith might be ‘working alliance’. A working alliance is a good relationship between you and your therapist - you know you are on on the same team. You are on the case together.

When we follow the breadcrumbs of your self we will encounter pain. And it will be difficult. But it will not be for naught. Together we’ll approach it directly in a new way because you and I on that day we approach it - we are new - never the same as we were before. And if we stay with your experience on that day and we work together who knows what we will find? Or, more accurately, who knows what will happen?

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Alison Crosthwait