The Decision to Begin Psychotherapy
When we choose to start psychotherapy, it’s not an easy decision. Is this the right time? How do I find the right therapist? Should it be a man or a woman? Does it matter if they they have personally experienced what I am going through like problems in sustaining long term relationships, the question of divorce, children, loss, depression, sexual anxieties, identity diffusion, struggles with anger, and death? If they have, will the therapist be colored by their own personal experiences and not be able to see me separately? Or if they have gone through similar life struggles, will they be more able to empathize with what I am going through? Do I ask them about these questions and will they tell me? These are all important matters to consider.
Psychotherapy is centered on two relationship paths. One is the one we have with our selves; the other is the one with the therapist.
A Relationship with Self
Psychotherapy is about building relationships, starting with the self. Effective psychotherapy invites patients to tell us about how individuals understand their problem, like depression. So, my goal is to help patients develop their own voice, to respect their view about what is making them so unhappy and making their path through life so painful. Symptoms like depression have meaning, that it is something to reflect on and potentially understand. Our symptoms need to make sense to ourselves. This is what I mean by having a relationship with oneself. For example, if someone has the habit of berating oneself based on unconscious devaluation, this certainly can trigger depression. If a person defends against acknowledging anger at one’s partner, anxiety and even panic can surface, sometimes seemingly out of nowhere.
People can resist this relationship with oneself. Our culture fosters quick fixes that promotes a view that a doctor simply provides a cure for a patient. There is no building of personal agency in this model, just dependence on a therapist. As Dr. Jonathan Shedler says, “So the goal is not to make psychotherapy faster. Psychotherapy is about slowing things down-so we can begin to see and understand the patterns that otherwise happen quickly, automatically, without reflection or awareness.” It can take time to be able to articulate one’s inner experience.
A Bond with the Therapist
Not everyone is a good fit with any particular psychotherapist, but we need to feel a genuine connection with a therapist. Research shows that this may be the single most important element of successful psychotherapy. Can I feel safe with this therapist? At the beginning of treatment, patients need to develop a therapeutic alliance with the therapist. Trust that the therapist is fully present and can understand the world of the patient are critical features of this alliance. The therapist needs to shuttle between concrete steps to help the patient feel better and a deeper understanding of what lies at the heart of the problem. Themes emerge such as never feeling good enough, or having to silence one’s own longings in order to keep the peace, or continually taking care of the needs of others. Bottom line is the patient needs to feel that the therapist “gets me”.
What typically happens in treatment is the reawakening of feelings that one had in our family of origin, very old feelings that have stayed with us through adulthood. We can re-experience those feelings within the therapeutic relationship. Feelings like the therapist is siding with others and not me, or the therapist seems bored, or the therapist seems opinionated and judgmental. These are just examples of what can be called transference and the therapy works best when these feelings are openly discussed and genuinely explored by the therapist. When the past comes alive in the relationship with the therapist, a curative process unfolds. Similarly, when the therapist listens in a way that feels different from the past, healing is possible.