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How Therapy Works: What it Means to "Process an Issue"

What do we mean when we speak of “processing an issue” in therapy?

Photographee eu/Shutterstock
Source: Photographee eu/Shutterstock

People are often advised to go to therapy to “process” some issue. But what does “processing an issue” actually mean? And why and how does this “processing” help?

For starters, we may define “a process” as a series of actions or operations taken toward achieving a particular end. “To process,” hence, is to perform a series of operations on something in order to change (or preserve) it—processing milk to make cheese or yogurt, for example. In therapy, these operations are performed through the therapist-client interaction, and they may take several forms.

First, processing an issue in therapy may mean working to place it inside a coherent life narrative. We experience our life as a story, of which we are both protagonists and narrators. And we make ourselves known to others in this manner, too. If someone wants to genuinely get to know you, giving them a list of facts and numbers describing you will not suffice. They will want to hear your story. For human beings, processing information involves organizing it in narrative form.

In this framework, shocking or traumatic events damage us by disrupting our stories, mangling our established narratives of self and the world. They do this by refusing to fit into our established narrative (“This is not me; this can’t be happening”) or by flooding and overwhelming it (“I can’t stop thinking about it; nothing else matters”). To “process an issue” in this case is when therapy helps us to either integrate the traumatic event into our life's narrative or pull our story out from under the weight and confusion of the trauma.

Second, processing an issue in therapy often means bringing past events or habits into present consciousness and analyzing them using our current tools and knowledge, resulting in fresh insight. One reason this is helpful is because difficult events often lead to avoidance. Places, emotions, and memories associated with the traumatic event are avoided, and thus they fail to undergo the constant reevaluation and examination that would have updated their meaning in light of new knowledge and experience. Thus, the meanings of these difficult events remain frozen in a past perspective. This means that the only reactions in our repertoire regarding these events are our original ones, which by now may be dated, ill-fitting, or suboptimal. If a dog bit you when you were 4 years old, leading you to hate dogs and carefully avoid any contact with them, whenever you do finally encounter a dog, you will have the terrified reaction of a traumatized 4-year-old, which you no longer are; likewise, the dog you are responding to is the one from your childhood, not the one in front of you now. Such a rigidly disproportional reaction is, by definition, neurotic, and neither healthy nor helpful.

Another example: Children often experience their parents’ divorce in real time as somehow their fault, and thus may harbor guilt and self-doubt related to the event even many years later. Observing the events of a divorce from an adult perspective allows the client to realize that their parents’ divorce was not their fault, and that the childish expectation that their behavior could somehow have mended their parents’ rift was both developmentally understandable, even inevitable, but also factually incorrect, even absurd, when viewed from the perch of the grown-up perspective.

“Processing” in this context often includes not only updating and reexamining the meaning of old memories and emotions, but also developing a new language with which to describe, experience, and understand the past and present. Moving from a language of powerlessness (“I’m a victim”) to a language of resilience (“I’m a survivor”) is one example. Moving from self-demeaning, perfectionist language (“I made a mistake; I’m stupid, deserving of punishment”) to a language of empathy and self-nurture (“I made a mistake; I’m human, deserving of compassion”) is another.

A third way to understand the notion of “processing an issue” is through the prism of cognitive developmental theory, specifically the seminal work of the pioneering cognitive theorist Jean Piaget. According to Piaget, the child is akin to a scientist, exploring her environment and experimenting with its properties in order to gain an understanding of the world and its laws. As the child experiments with objects, she learns about the character and attributes of reality itself. The child thus develops cognitive “schemas,” the building blocks of her mental architecture. Piaget defined a schema as, "a cohesive, repeatable action sequence possessing component actions that are tightly interconnected and governed by a core meaning."

In other words, schemas are organized ways of interacting with the world. Through experience, our schemas over time become increasingly numerous, at once larger and more specific, and they help guide our movement in the world. Having acquired a "restaurant schema," for example, allows me to know how to behave and what to expect in any restaurant, even one I had never visited before. Because I have a "party schema," I know a party when I see it, I know how to behave at a party, and I have a set of party-related expectations by which to evaluate whether the party was any good.

According to Piaget, schemas develop through two cognitive processes: assimilation and accommodation. We assimilate when we use an existing schema to understand novel information. Accommodation happens when the new information cannot fit our current schema, and we must then adjust our schema to fit the information. My “mammals” schema may easily assimilate a lion glimpsed for the first time. But upon encountering a whale, I may need to change my schema to accommodate this new information. If your wife gives birth to a new baby boy, assimilating him into your "male family member" schema will be easy. Yet if your adult daughter decides to transition to become a man, then you may need to accommodate your old "male family member" schema to include transgender persons.

From this perspective, processing an issue in therapy amounts to an effort to assimilate and accommodate new information, to improve our ability to understand and move in the world more seamlessly and effectively.

Fourth, processing an issue in therapy requires that we engage it, think and talk about it. In doing so, we are practicing de facto exposure with regard to the emotions attached to the issue. Exposure is a therapy technique that lets a client face up to a scary or uncomfortable situation. The goal of exposure is to achieve physiological habituation, psychological mastery, and behavioral skill. Physiologically feeling your emotions and remembering your memories will result in nervous system habituation and, with that, lower anxiety. Psychologically confronting difficult memories will lead to a sense of agency, courage, and achievement. Behaviorally learning to feel, identify, express, and discuss one’s emotions will lead to improved communications and interpersonal skill. Moreover, with exposure, the client learns new associations regarding the issue at hand. (Through interacting with dogs, I begin to associate them with playfulness and companionship rather than with the pain of the initial attack.)

Processing in this context can be viewed as a way to familiarize a person with unfamiliar territory. When we process an issue, we learn the terrain, thereby becoming less afraid of it and more able to navigate within it.

Working for many years in this area, the influential psychologist Edna Foa has proposed that fear is represented in memory as a cognitive structure, a program to escape danger (e.g., you see a lion; your heart races; you run away). The fear structure however, may in the course of one’s life become faulty, acquiring inaccurate associations between benign stimuli and exaggerated fear response (e.g., you see a lion at the zoo; your heart races; you run away). In Foa’s system, emotional processing, achieved through exposure practice, involves activating a person’s fear structure and then introducing new information that is incompatible with earlier faulty associations (e.g., hanging around the lion’s cage is safe; your heartbeat will eventually come down; you don’t have to run).

Fifth, processing an issue in therapy means bringing the issue into the light of another’s benevolent attention. Such interpersonal light is often, as it were, the best mental disinfectant. We are social animals, and we define ourselves, and our circumstances, in part by others’ responses. For example, if you kill your enemies in socially approved ways (say, by becoming a soldier and going to war), then you become a hero, but if you kill your enemies in a way that is not socially approved (you poison your nasty neighbors), then you have become a murderer. It’s all about how others see and judge what you have done. Receiving a 5 percent raise at work will make you feel good, but only until you find that all your coworkers have received a 10 percent raise. Your mood is determined not by what happens to you, but by how it compares to the experience of others. For good or bad, social connectivity is our foundational psychological currency. As Alfred Adler argued a long time ago, in the human psychological calculus, social connection is akin to health. Social isolation is akin to illness.

The engine of therapy is the human connection at its core. In this context, processing an issue means communicating it inside a safe, supportive interpersonal space. A secret loses much of its power to paralyze and poison us internally when shared with others who are capable of resonating with our experience, accepting and understanding it. In the act of discussing difficult matters, we become less alone, less opaque to ourselves, and thus less fragile. We manifest and build our strength when we express and own our weakness.

In sum, therapy may help you “process” a difficult issue by helping to place it inside a coherent life narrative; by reviewing past events using current tools and knowledge; by adjusting your cognitive schemas to include new information; by helping you confront previously avoided uncomfortable feelings in order to increase your competence in managing them; and by bringing the issue into the light of another’s benevolent and empathetic attention, thus reducing shame, fear, and isolation.

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