Updated: Nov 5, 2021
For many who find themselves in a quest for growth or navigating stress in some capacity, this question is at the forefront of consideration. Will therapy work for me? In and of itself, this question is not a bad one, nor is it unreasonable. Of course, you want to know if you will get what you need from something you invest in. The barrier we encounter with answering this questions is the many confounding factors. Therapy is an investment. Clients participating in therapy are taking on an agreement with themselves and their therapist, perhaps even a loved one, that they will place effort toward improving an area that needs some work. In regard to therapy, we typically get out what we put in. Change rarely happens simply from the 50 minutes to one hour per week in a therapist’s office. No, it’s the practice during the other six days a week of what is uncovered in that therapist’s office. The therapist’s office can be seen as a controlled environment. The world outside of that office is where your life actually happens, therefore, is the place much of the work will be done. The exploring, consulting, and fine tuning is what happens in that therapeutic hour. So, will therapy be successful for you? Let’s explore what goes into therapy, what is necessary for the opportunity for growth or change, and realistic expectations for outcomes.
If you’ve ever been to therapy, you’ve likely signed an Informed Consent. With most Informed Consent documents is a phrase that reads something like, “There are no guaranteed outcomes in psychotherapy.” or “The therapist cannot guarantee specific outcomes of the therapeutic process.” I’ve heard clients note how off-putting that sounds, as if the therapist is taking money with no accountability for their contribution. Though this statement is not intended to communicate that sentiment, I certainly understand why someone might think this.
The specific outcomes in therapy cannot be guaranteed, because psychotherapy or counseling is not an exact science; nor are humans. Instead, it is a relationship in which a trained professional listens to a client express their current lived situation, where they’d prefer to be, and maybe even perceived obstacles that get in the way. The therapist, then, uses their training to understand the client’s perspective, lived experience, and the system they are trying to navigate, in order to offer insight and effective means of navigating said system to reach a goal of less distress. In some approaches to therapy, this involves diagnosing and treatment planing. I call this treatment plan a Road Map or Treatment Map. We all start where we are at the time we begin therapy. This includes symptoms, stressors, reactions to stressors (or stress), supports we have and/or need, beliefs about our ability to grow or improve our situation, and resources we have to help us. Then, we explore where we’d like to be, our destination. This is where the therapist and client discuss, imagine, create imagery for what life will be like if the distress is no longer present. We note what is different about that time compared to now, as well as differences in the way the client interacts with their world. In order to know we’re on our intended path, we identify milestones. These are changes in feelings, behaviors, thoughts, or interactions that indicate we and/or our system is improving. Of course, with any path, there are potential and actual barriers or road blocks. It’s important to understand a client’s perception of what is getting in the way of what they want, in order to help them navigate through or around them.
Now that a plan or navigation is in place, let’s focus on the people on this journey - the client and the therapist. Three basic and primary principles are necessary in order for therapy to have the opportunity to be successful - honesty, trust, and vulnerability. On the surface, this may seem like a no-brainer. However, each of these principles on their own can be difficult to achieve or sustain, much less all together, and with someone you’re just getting to know.
In the Merriam-Webster dictionary, honesty is defined as “adherence to the facts; fairness and straightforwardness of conduct.” Much of our work in therapy is discerning between our emotional attachments to what is factually happening in the moment, versus emotional attachments to stories we invent about what is happening - typically rooted in past experience or predictions of the future. Honesty can be uncomfortable, sometimes, as it may lead us toward seeing or uncovering something about ourselves, others, or our lives that we are not particularly satisfied with, or more intensely, ashamed of. However, to see these pieces of ourselves, others, and our environments as they are, we can then navigate them with facts of reality. To know what we’re working with allows us to better identify skills and tools to navigate it.
Trust. Many of us have heard throughout our lives that trust is the foundation of any healthy relationship. Why is that? Well, in order for one to allow themselves to be vulnerable, they want to feel safe doing so. This safety comes from the trust in the other person that what is shared will not be used as to shame or judge them. Trust is both built upon and leads to transparency, a component of honesty. From this trust, comes confidence in care and increased comfort in exploring the vulnerable places in our thoughts, feelings, behaviors, and relationships.
With a mutual agreement of honesty and trust in the therapeutic relationship, comes the confidence to be in, explore, and navigate vulnerability. The truth is, all of us experience vulnerability, whether we want to, or not. What’s healing, is acknowledging its presence, and examining it with curiosity rather than shame or judgment. It is not weakness, nor is it something to be fixed, cured, or avoided. Vulnerability, as defined by Brene Brown, PhD, LMSW, one of the leading experts on shame and vulnerability, is the presence of uncertainty, potential risk, and emotional exposure. As you’re reading this definition, you can likely identify times in your life when you’ve felt this way. In therapy, vulnerability is not something avoid or build defenses from. Instead, we embrace it as something that’s already happening. Again, being honest allows us to see things as they really are.
In summary, therapy is an agreement or partnership between a therapist and client. Within this agreement, the therapist agrees to create and foster an environment conducive for, and supportive of, you doing the work necessary for growth and healing. What is asked of the client, is to be honest with self and the therapist, trust that the therapist will treat them as human-beings while learning to navigate life in a way that works for them rather than against them, and be curious about the experience of vulnerability, and one’s relationship with it.