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Rom Brafman

Rom Brafman Ph.D.


What REALLY makes psychotherapy work?

There's something a little strange about the process of psychotherapy

When you try to think about it logically, there's something a little strange about the process of psychotherapy. You go see someone, a total stranger, usually once per week. That person listens, asks questions, maybe shares insights. But it's one-sided: You only talk about yourself.

There is a strong level of closeness, trust, and rapport that makes it unlike any other relationship. A therapist might feel like a friend (but it's not a buddy-type relationship), a family member (though you're unrelated), or a teacher (but it's not a formal educational relationship).

So here's this unusual situation. But somehow it works. It can alleviate virtually any psychological malady we know about. It's as effective--and some would argue even more effective--than any psychotropic drug that we've been able to manufacture. But the question remains: What is it about that mysterious process of therapy that makes it work?

Extensive research ( shows that the main factor at play is what's known as therapist-client "alliance." In other words, the degree to which you feel comfortable, connected, and part of a team with your therapist determines how effective therapy will be for you.

In a way, this makes sense. If you go to therapy and you just don't hit it off with the therapist--e.g. he doesn't get you, she's too quiet, he talks too much, she gives too much advice--then the work might suffer. But most people don't really think about alliance when choosing a therapist. We think of experience level, gender, age, style, theoretical orientation. But all these factors matter only to the degree that it helps you click with your therapist.

How do you know when you have a good alliance with your therapist? You look forward to your sessions. You leave therapy feeling like you've done a lot of good work and made progress. It's easy to open up and talk with your therapist. And, perhaps more importantly, you feel that your therapist really gets you. And studies show that by the end of the third session--yes, that early in the process--you should start feeling that bond taking place.

A lot of times clients end up with the "wrong" therapist. He might be kind and polite. She might be trying to be helpful. But for whatever reason, the connection is not there. But clients carry on hoping that things will improve with time, or they blame themselves for therapy not going well. The thing to remember is that not all good therapists are good for all people. Your best friend might swear by her therapist, but maybe for you it wouldn't be a good match.

If you think about trying out therapy, be extra sensitive to the alliance factor. Make sure that you feel comfortable around your therapist and energized by your interaction. And if the "magic" is not there, strongly consider starting with a new therapist. And if you've been seeing a therapist for a long time and you still don't feel comfortable with them, either bring it up with them or think whether it might make sense to switch to someone you might hit it off with better.

And if you're afraid of hurting your therapist's feelings--don't worry about that. All therapists have had situations where clients have left. It's a normal part of the process. As a psychologist, I encourage my clients, especially new ones, to ask themselves how the sessions are going, how they're feeling, and to make sure that they keep the bar high as far as alliance goes.

Now the next mystery is what is it about alliance that makes healing happen? What is it about that bond that allows the magic to unfold?