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.”

Broad, generic ‘methods’ exist, and even they seem almost identical. CBT, Gestalt, Narrative, Schema, the list is endless – google ‘schools of therapy‘ to begin. 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? In my opinion the therapist should 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).

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.

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.

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.

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.

-Michael

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