What do you do when you do therapy?

Someone recently asked me this question and it’s a logical one: What do you do in therapy? Clearly there are many, many ways to answer – clearly nobody answers the same way, right?

This question reminded me of something a GP of mine told me, about psychotherapists: “They’re all the same. It’s like getting a haircut.”

It’s true, excess redundancy exists in a field where you’d expect almost artistic or literary subjectivity. Broad and generic ‘methods’ exist, and even then, the methods seem almost identical. CBT, Gestalt, Narrative, Schema, the list is endless – google ‘schools of therapy‘ to begin your descent. So what do you ‘do’ when you ‘do’ therapy? How would you know a therapist was ‘good’?

This is where it gets a bit paradoxical; therapeutic method(s), settings, cost and level of education seem less important (per research) than who that particular therapist IS. The person is what matters – more than anything. The same goes for many occupations (teaching, medicine, etc.).

So, what qualities does a good therapist have? If I’m looking at the person and ignoring the jargon and academic titles, what are common elements? In my opinion, of utmost importance is that the therapist convey sanity/calm. Next, the therapist should be able to ‘reach’ you to help extend to you this ‘calm’. To do this, though, a therapist can’t be hamstrung by fear (and many are).

What’s to fear though? Any number of things. You could fear you’re a fraud, for instance. A therapist might fear intense emotions, clients or situations; they might fold and end up doing more harm than good. Therapists also fear the reaction of the client (judgement). The same things everyone fears – a good therapist is able to put that aside for you.

So, what are the giveaway’s that the therapist you found isn’t going to help you?

If a psychotherapist falls into one of the two categories below, rather than maintaining an on going balance between them, they’re probably not effective.

Therapist one is loud, takes up most of the “talk time”, and has black and white views. They want to tell you what to do rather than aiming you toward finding your own insights and solutions. They lack subtlety, and you get the feeling they’re not really listening.

Therapist two is evasive, gives indecipherable or rhetorical answers to questions (even ones that demand hard advice). They constantly go back to the same questions or rehash discussions of the exact same memories and stories – no progress is made.

People’s perceptions of and reasons FOR going to therapists now often boil down to seeking out one of those two types of surrogates. They are surrogate fixers/listeners – they are not helping you guide yourself toward being your own resource as they believe you will never improve.

Psychotherapy is a new thing. If you take Freud as the first example of a ‘modern’ therapist, it’s less than 100 years old.  Before that, other people functioned as therapist’s – astrologers, phrenologists, basically anyone who could relieve you of your uncertainty. If that didn’t work, they would send you off to get your head dunked under water until you became sane.

So – what do you do in therapy Michael? Also – what is it you think these other therapists are afraid of?

To begin, I’m not exempt. Secondly, not all therapists fit so neatly into prescribed types. Some are absolutely brilliant artists at their crafts (and it is a craft) – a true craft is unique.

I’ll answer the second question first. Therapists are afraid of not knowing what the point (deeper point) of what they’re doing in the therapy room is and they have a fear of silence emerging and pervading their ‘therapy session’. After all, we should be doing something, right?

When I’m the therapist? There might be a few moments of awkward silence – there might not be. I’m not going to speak when I feel you are getting ready to speak, when I would like you to speak, or when it’s just a ‘good’ moment to allow for silence as information is processed.

It’s common to feel nervous meeting a therapist for the first time, and I am no exception. I’m aware of this anxiety, though, and I do what I can to reduce that tension. I might use humor, I might do something idiosyncratic – I think that also humanizes me, which is also an important part of building rapport and conveying calm. Remember – I said the aim of therapy was to convey calm, not induce fear.

The point is to give me a chance to get to know you without doing it in stressfully direct way. Once your stress level decreases, your likelihood of beginning to talk about what’s really bothering you might surface. Once this happens, therapy passes quickly.

How long a person needs therapy for is not a certitude, it is their decision. People have periods of personal growth, followed by periods of stagnation – we’re always changing, and a therapist should recognize this.

Finally, when rapport is built and trust exists, when a person’s ‘story’ has been told, therapy becomes the process of taking away learned thoughts and behaviors that are hindering this growth process, and giving them space to discuss alternatives.

A good therapist offers you alternative ways of being yourself.



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