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How Does Psychotherapy Really Work? It’s Not What You Think

Destigmatizing psychotherapy through moments of meaning

CC0 Public Domain
Source: CC0 Public Domain

Psychotherapy is a strange process. Two people get together and they talk. Somehow through this conversation, one of them offers help and the other receives it. From an outsider’s perspective, there are all sorts of ideas about how this so-called “talking cure” works—most of them, by the way, are not true. One is that your therapist knows all the answers. Another is that he or she will tell you what to do. Another is that people listen to their therapists because therapists have it all together—also, not true. While we might wish for therapy to work in these ways, that’s not how it works at all.

The poet, Rainer Maria Rilke, understood something about the mystery of how an interpersonal encounter can change someone’s life. In his Letters to A Young Poet, he wrote, “Ultimately, and precisely in the deepest and most important matters, we are unspeakably alone; and many things must happen, many things must go right, a whole constellation of events must be fulfilled, for one human being to successfully advise or help another.”

The psychoanalyst, Wilfred Bion, took it one step further. He wrote, “When two people meet, an emotional storm is created.” I like this idea because it begins to convey something of the way in which psychotherapy is an alive, dynamic, turbulent process, not just a sterile exchange of ideas or mechanical prescription for behavior change. Therapy is a vital process, a charged experience. Its power to transform and bring about lasting personal change cannot really be understood from psychology textbooks or experimental research, necessary and helpful as these methods are.

I think that there are two good ways to understand how therapy really works. One is, of course, to be in therapy yourself. An insider’s experience is the most valuable one. But how do you get a sense of what psychotherapy is like before you’re actually in therapy? I mean, that’s when you really want to know, right? You want to have some sense of what you might be getting yourself into.

CC0 Public Domain
Source: CC0 Public Domain

The second good way to understand how therapy really works is through personal stories of those who have been in therapy. The psychologist Irvin Yalom has given us glimpses into his therapy office through his many books—among them, Love’s Executioner: And Other Tales of Psychothterapy; The Gifts of Therapy: An Open Letter to a New Generation of Therapists and Their Patients; and my personal favorite, Every Day Gets a Little Closer: A Twice-told Therapy (which I love because you get a view of the same therapy experience from both sides of the couch). I see on Amazon that Dr. Yalom has just released a new book, Creatures of a Day: And Other Tales of Psychotherapy, which I’ll have to check out.

Last summer, I came across a book in this same genre that looks at the stories of patients in the specialized type of psychotherapy that I practice, psychoanalysis. In The Examined Life: How We Lose and Find Ourselves, psychoanalyst Stephen Grosz shares his patients’ stories (with their permission, of course) in a way that conveys the mystery of the unconscious mind and gives a palpable sense of how the psychoanalytic encounter works. He shows how psychoanalysis helps us re-examine and so re-tell our personal stories. Even more compelling, he shows how psychoanalysis is an opportunity to re-live our personal stories in the interaction with the analyst, and how such a live encounter can wake us up and mobilize transformational change.

Ryan Howes - used with permission
Source: Ryan Howes - used with permission

Just this week, Psychology Today blogger and National Psychotherapy Day founder, Dr. Ryan Howes, has taken the telling of psychotherapy tales to a whole new level. He and his team have put together a series of videos called, Moments of Meaning, in which six mental health professionals share their experiences of psychotherapy. In these beautiful videos, they share meaningful encounters with their real clients (with full permission, of course); personal experiences in their own therapy; and the daily challenges of being therapists. There is a depth to these videos that is both illuminating and touching. One gets a real behind the scenes look into the minds and hearts of these therapists, the emotional and caring connection that they have with their clients, and the very human nature of this psychotherapy business. These are real therapists telling real stories about what really happens in psychotherapy. And they are really good.

The experience of psychotherapy requires vulnerability, courage, and an open heart. I hope that some of these resources will be useful for those of you thinking about taking the chance and reaching out. In a culture that is so often isolating and alienating, it is a gift to be able to tell our stories to someone able to hear and understand them in a deeper, more meaningful way. In the end, that is how therapy really works.

Copyright 2015 Jennifer Kunst, Ph.D.

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