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Understanding the Core of Psychotherapy

Psychotherapy, described through concepts that we call the six M's.

Key points

  • Therapy is sometimes referred to as the talking cure, but that only highlights that conversations are the primary medium.
  • The primary maladaptive processes that drive people into psychotherapy are negative situations.
  • These negative situations trigger negative feelings and reactions.

Co-authored with Waldemar Schmidt1

What is psychotherapy, and what does it do? A satisfying answer is not easy to find. Conventional definitions do not help much in clarifying the matter. There are basic descriptions of who provides therapy and the formats and schools of thought. But here we attempt to give a clearer picture of what psychotherapy is and how it works. Therapy is sometimes referred to as “the talking cure,” but that only highlights that conversations are the primary medium.

One key distinction that we believe will be helpful to readers who are trying to get a better grip on exactly what psychotherapy is is to separate process from content. Content refers to the “what” of therapy. Specifically, the kinds of problems the client brings to the therapist (relationship problems or problems with depression and anxiety), what the therapist asks about, and the kinds of interventions developed to make changes. The process refers to the "how" of therapy. And it is here that we can focus on helping readers deepen their understanding of what the core of therapy is about.

First, some definitions are focused on “dysfunctional emotional reactions, ways of thinking and behavior patterns.” What are dysfunctional ways of feeling, thinking, and acting? This can be framed in process terms. Usually, a negative situation (or set of situations) triggers strong negative feelings over time. In addition, there is a set of secondary negative reactions that the individual or group engages in as they try to deal with the negative situation and negative feelings.

This is called a triple-negative neurotic loop—negative situations that trigger negative feelings that trigger negative reactions. The final negative here refers to negatives in the maladaptive sense. Usually, people respond and try to cope via avoidance, blame, or control, and these reactions make things worse and make the client feel worse. This creates a loop because they try harder to avoid, control, or blame.

This triple negative neurotic loop is a dysfunctional process because, like bringing water to a grease fire, the negative reaction generates more trouble than it solves and thus becomes self-perpetuating.

This describes the process of thinking, feeling, and acting rather than content—the specific problems, feelings, and actions in context. From this, we can proceed to frame the psychotherapy process as attempting to engage in cultivating a new way of relating to the world and one’s thoughts, feelings, and actions.

The general way psychotherapy tries to cultivate a shift in process in a way that can be framed by what we call the six M’s:

  1. Mindfulness–to explore what is going on in their life with awareness and acceptance, in contrast to operating mindlessly on “autopilot."
  2. Meditation–to contemplate what is going on, its significance, and how it is affecting their life and the lives of others.
  3. Metacognition–to carefully consider what it is they think about and what they think about what they think.
  4. Meta-affect–to carefully consider what they feel and what they feel about their feelings.
  5. Metanoia–to recognize that change is warranted, consideration of their options in amending their modus operandi, and how to bring about the needed and selected changes.
  6. Motivation–to recognize the need for continued observation and alterations and how to maintain that approach. Psychotherapy is not a “one and done,” but it provides access to a more resilient way of life.

These six Ms describe the way psychotherapy shifts one’s perspective on the processes of living. Specifically, people get trapped into neurotic loops that engender much suffering. There is a process of relating to people in those positions and helping them shift from living mindlessly within them to becoming psychologically mindful of them. This, in turn, opens shifts from maladaptive to more adaptive patterns of thinking, feeling, and acting, as well as relating to others.

We believe that clarity can be achieved via shifting the focus from trying to describe therapy via the content of disorders, approaches of schools of thought, or primary formats to an emphasis on how therapy cultivates a shift in processes that enable more reflective awareness of what is happening. It should also focus on what has happened, how one can be more accepting of negative situations and negative feelings, and how one can learn to avoid maladaptive reactions and cultivate more adaptive reactions systematically.

As such, the six M’s of psychotherapy might help the public better understand the core of therapy.

To find a therapist near you, visit the Psychology Today Therapy Directory.


1. Waldemar A Schmidt, PhD, MD, is Professor Emeritus at Oregon Health and Sciences University in Portland, Oregon. He, his anatomist wife and their dog live outside of Oregon City, the original “capital” of the Pacific Northwest Territory. They reside in a house within a Douglas fir forest, where Waldemar continues his earnest study of psychology, the human condition, and “mental dysfunctions.”