Psychotherapy: It's All About the Relationship

Most people I talk to don't really understand how psychotherapy works.  Insurance companies are all about the least expensive, most efficient method of symptom reduction.  For this reason, they often recommend short-term approaches that focus on symptom reduction.

It's important to understand that symptom reduction is different from problem resolution or understanding.  It's about returning the person to their pre-symptom state, not addressing the underlying issues that may have created the symptoms in the first place.  In addition to symptom reduction, psychotherapy offers change/growth and self-awareness.  Unproductive patterns are understood, dismantled, and replaced by self-care and compassion.

An example might help clarify what I'm talking about.  If you suffer from chronic headaches, the quickest, most efficient intervention might be to take some ibuprofen.  It gets rid of the pain, and you can quickly move onto the next thing.  And that might be the best approach to take.  An alternate approach might be to figure out what's causing the headaches, so you can understand what's happening, and make the necessary changes to decrease your headaches.  Is it stress, hormones, diet, brain chemistry, etc?  

What does psychotherapy offer?  Psychotherapy helps you develop self-trust and self-control.  It helps you identify relationship patterns (both with yourself and others), understand where they come from, and make positive changes.  It can help you accept and work with what you can't control about yourself.  Psychotherapy can also help you move forward when you're feeling stuck or trapped.

Some therapists take a purely symptom management approach, but most therapists tend to be more integrative, having a primary theory they work from, and adding other methods as necessary.  What we have learned from the research, after years of outcome studies, is that the single best predictor of therapy outcome, regardless of how it's defined, is the quality of the therapy relationship.  Basically, having a good working relationship with your therapist is the most important factor to meeting your therapy goals.

So how is a good relationship transformative?  I think about the therapy relationship on multiple levels.  The first level is about liking and trusting your therapist enough to begin sharing personal information.  The therapist's job is to create a safe enough environment for you to share, reflect, and explore.  

Another level involves using your therapist as a guide.  Good therapists have done their own psychological work.  They have spent a lot of time reflecting on how they moved themselves through various life struggles and developmental moments.  By mining their own journey, they are able to use their experience to guide you through yours.  It's not advice so much, though it can be, as sitting with you in the dark and using their flashlight to draw your attention to the markers along your path.

The third level, the transference level, also plays a key role in change.  This level involves the unconscious of both the therapist and client.  Transference is a process in which thoughts and feelings from a relationship or situation in the past are projected onto a relationship or a situation in the present.  Therapy involves bringing unconscious projections into conscious awareness, thus changing how we experience relationships and situations.  Symptom focused approaches may not allow for the exploration of this phenomenon.  They tend to focus on conscious thoughts and behaviors, leaving much of the meaning behind the patterns out of our awareness.