Psychotherapy – How It Works


psychotherapy with two menIt takes guts to pick up the phone and make a psychotherapy appointment.  Rarely does anyone decide to change until the pain they’re in is worse than the fear of the unknown.

That’s what it means to change—leaving the known of who I am and how I behave.  The familiar is safe even when it hurts.  For the therapeutic relationship to work, it’s important that counselors understand what hurdles clients face.

Often, people feel uneasy about starting therapy, but may not be aware of exactly what are their concerns. They usually fall into one or more of five categories. Identifying what they are and what to expect can help put you at ease.

Hurdles to Seeking Therapy

The following are five misgivings people have about commencing psychotherapy:

  1. Most people don’t feel good about themselves. They have trouble admitting this as well as things they feel ashamed of in their past. A lot of people are afraid of looking at themselves and discovering something awful that’s deeply buried. The problem is not what they imagine but their own shame and insecurity.
  2. A lot of us were taught not to share our “dirty laundry” and that it was wrong to talk about your business with others, especially strangers. Talking about problems with a therapist can violate those family values and even feel like a betrayal of our parents. However, those rules stem from shame that is pervasive in dysfunctional families that most of us come from. Our secrets keep us sick. Sharing is the beginning of healing.
  3. There are many people, especially men, who are reluctant to ask for help. Most people don’t want to admit they need it.  To some, it’s a weakness or a failure. Our culture prides itself on self-sufficiency, independence, and invulnerability. They don’t realize the strength in vulnerability and the power of surrender.
  4. Additionally, when our self-esteem is low, we may not feel we worthy of investing in ourselves or our happiness. We may have received messages in our youth that we undeserving or that life should be painful. Our culture values material belongings over peace of mind, but without the latter, we can’t enjoy the former.
  5. Finally, seeking therapy also represents the beginning of putting our trust in someone other than ourselves. If we grew up not trusting our parents, we’re taught not to trust others or have experienced betrayal, we will be leery of opening up to someone we don’t know.

Starting Therapy

Giving up the pretense of “I’m managing just fine,” may be triggered by a crisis, an illness or a major loss, or progressive symptoms, such as anxiety, insomnia or depression.  Whatever the situation, it presents an opportunity when that person is teachable and willing to receive.  This in itself opens the psyche to the possibility of change.

Some individuals or couples enter psychotherapy with the idea of changing their partner, or they come because someone gave them an ultimatum.  They may be in denial about their pain and their contribution to it. Some addicts only want to exam why they do what they do without giving up their addiction. They’re unaware that their addiction is a major cause of their suffering and that they have the power to change.  The initial period of counseling is about shifting the focus to themselves.

The Relationship with a Therapist

The most important factor in change is the relationship with the psychotherapist – more important than if the counselor is a psychologist, family therapist, or social worker.  Just the therapist’s caring and active listening bring about change.  Several things are happening.  First, the individual is beginning to trust someone, meaning they feel safe enough to tell the truth. It may be the first time he or she ever revealed private thoughts to anyone, which builds self-esteem.  It is a statement of who I am.  “Someone is listening to me…I must be worthwhile.”  Moreover, just the act of talking about a problem affords some relief and gives a person a sense of objectivity and control over the situation.

Two other vital ingredients the therapist brings to the healing process in psychotherapy are non-judgmental acceptance of the client’s feelings and thoughts, as well as accurate empathy, conveying to the client that he or she is really understood. Consequently, it is important that the therapist not lecture, advise or judge the client, but instead try to see the world from the client’s point of view, and to let him or her know that you really “get” what it is like for him or her.  This makes it safe for clients to tell their story and becomes the foundation for self-knowledge and, ultimately, self-love. It also models how they can relate to themselves.

Self-esteem increases, their false beliefs are challenged, and feelings of shame diminish. Clients trust themselves more, take greater risks in being authentic, and with each step build a stronger core of self.  In risking being who they are, in speaking their truth, clients are really learning to trust themselves and become more of who they are. The need to please, achieve or look good dissolves, as increasing spontaneity and congruence between what the client says and does and how the client inwardly feels.

Psychotherapy as a Lab

As a “relationship” develops between therapist and client, trust and rapport build, and the therapeutic relationship itself begins to play an important function in self-awareness and change. It is a prototype of the client’s interactive behavior in all of his or her other relationships, particularly intimate ones.  Is the client being tentative, entertaining, manipulative, seductive, oppositional, or feeling judged, exploited, misunderstood, ashamed, or abandoned?

Interestingly, the same actions of the therapist may have very different meanings to different clients.  The client’s view and interpretation of the therapist, called “transference,” disclose much about how the client sees the world and others in his or her life.  Take for example, a situation where the client is kept waiting a few minutes.  One client blames him or herself, thinking it was his or her mistake as to the appointment time; another client assumes the therapist forgot the appointment and feels abandoned; another feels jealous that the therapist is involved with someone else; while yet another is angry that he or she won’t get a full hour.

Finding links between the transference and the client’s relationship with his or her parents explains how their childhood still affects and often interferes with adult functioning.  Clients may discover that many of their patterns and beliefs are actually distortions of reality, which were developed at a time when they believed their survival depended upon their parents and served to make sense of their childhood reality. When a therapist can present a different perspective and empathetically understand the client’s experience, those old wounds begin to heal.  Thus the therapy room becomes a laboratory to both examine the client’s feelings and behavior towards the therapist and others, and also is a safe place to try out new ways of being that are later tested in the world.

The client’s increasing self-awareness and introspection generate the development of an observing ego, and gradually with awareness comes choice and a sense of mastery. As clients become more conscious of their attitudes and behavior, they’re no longer as reactive and controlled by their habitual patterns. Next can be the challenge of trying out new behavior outside of therapy, such as leaving or starting a job or relationship or setting boundaries. A therapist is a guide that can both assist and offer support.

Psychotherapy can hardly be considered a self-indulgent luxury.  It is certainly not for the faint of heart, but requires tremendous courage.  Those who are committed to their growth and decide to weather the storm discover the joy and contentment of being free to be fully themselves. There is greater strength, resiliency, and courage to risk, as well as genuine feelings of zest, passion, and joy for life.

Read more about couples counseling.

Copyright, Darlene Lancer, 2008



Share with friends
Notify of

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Inline Feedbacks
View all comments

Recent Posts


To get your Free “14 Tips,” please provide your name and email to join my mailing list and monthly blog.

Check your spam folder, and email me if you don’t get an email confirmation. (See our Website and Privacy Policies)