What is therapy?
As a therapist, I continually ask myself basic questions about therapy. What is “therapy?” When does therapy work? How do I know it is working? What is the ultimate point of therapy? Am I doing all the things I should be doing to help make the process as valuable and beneficial to my client as it can be? What kind of therapist am I? These are important, complex, and not easily answered questions. I am sure I will need to repeat these questions to myself and my colleagues for as long as I am a therapist. I hesitate to think what might happen, how inattentive, lazy, or just plain ineffective I might become if I decided I knew the answers to these questions completely. Let’s just say I know myself well enough to know this is not very likely! I don’t trust and am not all that interested in definitive answers to these questions. I trust an evolving process which keeps me attentive and interested in my own internal processes and the process of doing therapy with clients that teaches me every day in every session something new about therapy, myself and my clients.
So, then, what is “therapy” (by this I mean “psychotherapy” not any of the other kinds, like physical therapy, etc.)? Therapy is a process in which therapists and clients (individuals, couples, and families) engage in private meetings that are comfortable enough to allow them to work together to explore, identify and propose possible solutions to emotional and mental health issues faced by the clients which the client considers, modifies and implements all to bring about the changes desired by the client.
This simple description means that therapy has the following basic and essential components:
4) Trust or “comfort;”
5) Client desire for change;
6) Therapist expertise in facilitating helpful process
7) Exploration of problem;
8) Identification of causes;
9) Proposed solutions; and
10) Implementing solutions.
It is surprising, isn’t it, that what seemed like a fairly straightforward process has so many parts. I could probably even identify more details, but this list seems to illustrate the point: therapy has many varying and important components. Like I said, the questions at the beginning of this discussion are complicated and difficult.
None of the other components in therapy make any difference at all unless the client both wants to make change in their lives and has some basic level of trust or comfort that the process is likely to lead to the kind of change she or he is seeking. Now that leads to other questions, like how does the client know what kind of changes he or she might want in their lives? How can the client begin to trust the therapist has the kind of skills, knowledge, abilities to help the client identify those changes, and how they can be achieved? A client could, for example, trust that a therapist is genuinely interested in their well-being, is passionate about their work, will keep things confidential, will not judge them, cares about them, but still not know or be sure or trust that this particular therapists understands their issues well enough to really help them.
The best I can say for now is that, first of all, and obviously, not every therapist is going to be right for every client. Second, therapy is an evolving process. At one point in a client’s life, he or she might benefit from a therapist who is “client-centered,” who is mostly a sounding board, offering little feedback, and offering mostly care, support, and quiet empathy. This might be just “what the doctor ordered” when a client is in the middle of a transition period. This approach might be woefully inadequate later on, when the client has moved beyond that transitional or emotionally traumatic situation, and now wants to look back at it in detail to understand why it happened, and how they need to do things differently to avoid a repeat of that situation. At that point, they might want a therapist who is far more probing. The same therapist could do both, but maybe not. The client needs to be as open and aware as they can be to determine what their needs are, and whether their therapist can meet those particular needs.
Hopefully, the therapist will be equally aware and open about how they approach therapy in general, and what ideas and methods they might be able to utilize to help clients find the solutions that work best for them. Just as not every therapist is going to be able to meet the needs of every client, not every client’s problem is the kind of problem any particular therapist might be well-suited to help solve. I tend to avoid working with young children, knowing there are those therapists out there who are better able and more interested in providing such services. Don’t get me wrong, I like children and always enjoy when clients bring their children into sessions so I can meet them, or in case they are part of the issue, or the client couldn’t find a sitter. After working with children in the first several years of practice, I found myself not being all that good at it, not knowing how to help them in ways other therapists seem to know. Part of knowing what you do well is knowing what you don’t do so well. So, when someone asks me to see their child under the age of 14, I refer them to therapists who are better able to meet those therapy needs. I also refer to other therapists those whose primary therapy issue when they contact me is an eating disorder. Again there are specialists out there who really know what they are doing with this issue, and I am not one of them.
There are studies that show the therapist’s technique is definitely not the most important factor in determining the success of therapy. Before learning about these studies, I had found this to be true when I was a therapy client, so I had some personal observations that confirmed the truth of this. Those studies show that the most important factor is client motivation for change. Check! The second most important factor is the nature of the relationship between the client and the therapist. Check! A distant third factor is the kind of techniques or approach of the therapist. Check! In my years in and out of therapy (see my blog on my experiences as a therapy client), the most effective by far was a Licensed Marriage and Family Therapist. Not because he focused on how to help my family function better—he never met anyone in my family, only working with me as an individual client for several years. My therapy with him was effective because of the kind of therapy relationship we established. The rest, his training, his therapy approach, his ideas about psychotherapy, were a very minor part of what made our therapy so helpful. He was open-minded, sensitive, didn’t try to tell me who I was, and he also seemed to just “get” me. This was exactly what I needed at that time in my life with those issues I brought to therapy.
A good match between the client and the therapist means the client believes that this particular therapist is well suited to be able to understand the client, their problems, and the therapist will have some good ideas about how to help the client move through those problems so they can understand themselves better and make the kinds of changes that they deem necessary to solve their problems. This will also reinforce the client’s motivation for and belief in the possibility of positive changes. Maybe, then, a partial but pretty good answer to the question, “what is therapy” is this: Therapy is a relationship between a client and a mental health professional in which they are both invested in exploring the client’s mental health issue in a way that feels safe and productive so the client can try different ways of resolving the issues with the help of their therapist. It’s not a complete answer, but it’s a pretty good start.
Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.