How Psychotherapy Works

when one is in a bad place in one’s head
the modern world offers three main
sources of help psychiatric meditation
CBT and psychotherapy each one of these
has its own advantages and drawbacks
medication can be exemplary in a crisis
at points when the mind is so under
siege from fear anxiety or despair that
thinking things through cannot be an
option correctly administered without
requiring any conscious cooperation from
us
pills play around with our brain
chemistry in a way that helps us get
through to the next day and the one
after we make it very sleepy a bit
nauseous or rather foggy in the process
but at least we’re still around and
functioning more or less then there is
cognitive behavioral therapy CBT
normally administered by psychologists
and psychiatrists in six to ten hour
long sessions which teaches techniques
for arguing rationally with and with any
luck at points controlling the ghoulish
certainties thrown up by our internal
persecutors paranoia low self-esteem
shame and panic lastly there is
psychotherapy which from a distance
looks like it has only drawbacks
psychotherapy has a very hard time
showing its efficacy in scientific
trials and it has to plead that its
results are too singular neatly to fit
the models offered by statisticians also
it takes up a large amount of time
demanding perhaps two sessions a week
for a couple of years and it’s therefore
by far the most expensive option on the
menu
finally psychotherapy requires active
engagement from its patients and
sustained emotional effort what cards
simply allow chemistry to do the work
and yet psychotherapy is in certain
cases a hugely effective choice which
properly alleviates pain not by magic or
chance but for three solidly founded
reasons firstly our unconscious feelings
become conscious a founding idea of
psychotherapy is that we get mentally
unwell have a breakdown or develop
phobias because we are not
sufficiently aware of the difficulties
we’ve been through somewhere in the past
we’ve endured certain situations that
were so troubling or sad
they outstripped our rational faculties
and had to be pushed out of day-to-day
awareness for example we can’t remember
the real dynamics of our relationship
with a parent we can’t see what we do
every time someone tries to get close to
us nor trace the origins of our
self-sabotage or panic around sex
victims of our unconscious we cannot
grasp what we longed for or a terrified
by in such cases we cannot be healed
simply through rational discussion as
proponents of CBT
implicitly propose because we can’t
fathom what’s powering our distress in
the first place psychotherapy is a tool
for correcting ourself ignorant in the
most profound ways it provides us with a
space in which we can in safety say
whatever comes into our heads
the therapist won’t be disgusted or
surprised or bored they’ve seen
everything already in their company we
can feel acceptable and our secrets
sympathetically unpacked
as a result crucial ideas and feelings
bubble up from the unconscious and are
healed through exposure interpretation
and contextualization we cry about
incidents we didn’t even know before the
session started that we’ve been through
all felt so strongly about the ghosts of
the past are seen in daylight and a laid
to rest there’s a second reason why
psychotherapy can work so well
transference transference is a technical
term that describes the way once therapy
develops a patient will start to behave
towards the therapist in ways that echo
aspects of their most important and most
traumatic past relationships
a patient with a punitive parent might
for example develop a strong feeling
that the therapist must find them
revolting or boring Oh a patient who
needed to keep a depressed parent
cheerful when they were small might feel
compelled to put up a joky facade were
never dangerously sad
Epic’s come into view we transfer like
this outside therapy all the time but
there what we’re doing doesn’t get
noticed or properly dealt with
however psychotherapy is a controlled
experiment that can teach us to observe
what we’re up to understand where our
impulses come from and then adjust our
behavior unless unfortunate directions a
therapist might gently ask a patient why
they’re so convinced they must be
disgusting or they might lead them to
see how their use of jokey sarcasm is
covering up underlying sadness and
terror
the patient thereby starts to spot the
distortions in their expectations set up
by their history and develops less
self-defeating ways of interacting with
people in their lives going forward then
the third reason why psychotherapy works
it is the first good relationship we are
many of us critically damaged by the
legacy of past bad relationships when we
were defenseless and small we didn’t
have the luxury of experiencing people
who were reliable who listened to us who
set the right boundaries and helped us
to feel legitimate and worthy
however when things go well the
therapist is experienced as the first
truly supportive and reliable person
we’ve yet encountered but they become
the good parent we so needed and maybe
never had in their company we can
regress to stages of development that
went wrong and relived them with a
better ending now we can express need we
can be properly angry and entirely
devastated and they will take it thereby
making good years of pain one good
relationship becomes the model for
relationships outside the therapy room
the therapists moderate intelligent
voice becomes part of our own inner
dialogue we are cured through continuous
repeated exposure to sanity and kindness
psychotherapy won’t work for everyone
one has to be in the right place in
one’s mind one has to stumble on a good
pissed and be in a position to give the
process due time and care but all that
said with a fair wind psychotherapy also
has the chance to be the best thing we
ever get around to doing if you’re
interested in trying psychotherapy the
School of Life offers a service in
person in London or by Skype around the
world click on the link for further details