What is Psychotherapy?

The Psychotherapeutic Relationship

Psychotherapy is variously referred to as talk therapy, counseling, or simply, therapy. There are various definitions of the term, “psychotherapy”, and it would be tedious and nearly impossible even for a mental health professional to provide a singular definition of what psychotherapy is. There are many different modalities of psychotherapy, and many different theories about why humans are the way we are. But the unanimous finding based on years of research is that there is no one type of psychotherapy that is better than another. The unanimous finding also is that the success of psychotherapeutic work almost single-handedly depends on the strength of the relationship between the therapist and the client- the relationship between you and me. Hence, I believe it would be more helpful for me to tell you what psychotherapy would look like when you and I work together. Because if you are able to get a sense of how I view our work, then you may be in a better position to determine the beginning of our relationship.

The “Why”

Psychotherapy, as I see it, seeks to understand the “why” or the motivation behind our thoughts, feelings, and actions. If I think certain thoughts, then why do I think them? If I feel certain emotions, then why do I feel them? If I act certain behaviours, then why do I behave so? Seems simple enough, right? All I need to do then is just ask myself these questions, and wait for my mind to reply.

However, that’s where the difficulty lies. A lot of times, we are not consciously aware of why we think, feel, or act in a certain way. For instance, you may be experiencing a great deal of anxiety every time you need to speak or express your opinion during a work meeting. Granted, a certain degree of nervousness may be expected for all of us when we need to speak up in a group setting. But your anxiety feels really overwhelming. You may feel a tightness in your chest, your breathing becomes rapid, your palms start to sweat, and you forget what you wanted to say in the first place. You may wonder why you feel so anxious, you wonder why you get so nervous even though your boss and colleagues seem to respect your opinions, and don’t criticize you when you speak up. At least consciously, you are unable to understand the reason for feeling so anxious.  

Working Towards Awareness

Here is where psychotherapy finds its place. Each week, you sit down with me, your therapist, and have a conversation. During each conversation, you can talk about what is important to you, what is troubling you, what feels tough or difficult for you, what angers and frustrates you. Or you could even talk to me about what or who gives you happiness, pride, laughter, meaning. Or you could just choose to experience some silence, just sitting with whatever is happening within you. You don’t always need to be talking. Essentially, you get to decide what you would like to explore, or understand, or work towards during our sessions. And I ensure that our conversations are directed towards the goals which you have in mind.

So, going back to the example of feeling anxious about speaking up at work. You would come into therapy with the goal of identifying why your anxiety feels so overwhelming, and what steps you could take to manage your anxiety. Now, you may not want to really understand why your anxiety feels overwhelming. You may just want to know how to manage your anxiety. And, technically, I could guide you through some ways of managing your anxiety. For example, I could walk you through some breathing exercises which help ground you in the present moment. Breathing deeply and intentionally, helps you to at least temporarily detach yourself from the spirals or cycles of anxious thoughts and feelings. Or I could help you engage in a process called cognitive restructuring, which helps you identify unhelpful, negative thoughts about yourself and the world, and substitute them with more helpful and adaptive ways of thinking.

Short Term vs. Long Term Relief

But, in my experience, while these techniques could help you feel better in the short term, they may not always translate to long-term relief. The techniques help alleviate the symptoms of anxiety. But they don’t help you understand why these symptoms exist in the first place. And if you don’t understand why these symptoms exist, then there’s a possibility that these symptoms will continue to show up again and again. And this I believe is the purpose of psychotherapy- to understand the root cause of the symptoms of your troubles- whether it be anxiety, depression, relationship issues, or professional problems. When you understand the cause of your anxiety for instance, you realize why the emotional and physical intensity of your anxiety feels so overwhelming. This in turn helps you better identify situations which will trigger your anxiety, so that you may take steps to either manage your anxiety or deal with the situation in a more helpful manner.

The Impact of the Past

When you were a child, maybe your mother would tend to put you down or ask you to remain quiet when you expressed your opinions in front of the family. Maybe your father rarely showed interest in the things which you were interested in. Maybe your teachers called you stupid for not scoring well in the subjects which were taught at school. Maybe you rarely had the chance to participate in conversations because your friends were louder and more talkative. Maybe societal norms and prejudices made you feel like your experiences aren’t as valid as those of others. If each of these situations or a combination of these situations were occurring often enough, you were essentially receiving the constant message from people that you aren’t important enough, you aren’t interesting enough, you aren’t good enough, you aren’t smart enough. You may have started to believe that your opinions or ideas are worthless, and that if you did express your opinions or ideas, you would either be criticized for them or not listened to.

And so when you consider the anxiety you experience at work when speaking in a group setting, we can see that there is a more significant reason as to why it feels so overwhelming. It’s not simply that group situations can feel intimidating. No, over the course of your life you experienced a pattern of situations that kept reinforcing your belief that you are not smart enough or important enough to be heard, or to be taken seriously. And so, in your work meetings, the combined weight of these past experiences is making you anticipate that your present experience will be no different from your past experiences. You anticipate that the same feelings of hurt, neglect, disappointment, frustration, and sadness which you felt during past experiences, will be felt again in your present experience. Even if your colleagues might not criticize you. Even if they may listen to you, and value what you have to say.

It’s All About the Process, and the Process Takes Time

Psychotherapy thus finds its value in helping you understand the core, foundational reasons for the issues which you are experiencing in the present. By recognizing the patterns of thinking, feeling, and behaving which have been established over the course of your life, you may start to experience a certain degree of control over how you view and respond to situations in the present.

I realize that I might be simplifying this process. And the truth is that psychotherapy can be a long-term endeavour. It involves work, work which often might seem non-linear. Confusing, frustrating, intrusive, disruptive, and sometimes frankly unhelpful. It involves confronting uncomfortable emotions, it involves confronting incredibly painful experiences and relationships which have shaped who you are as a person. It involves staying with the uncertainty of the process of change. At the same time, psychotherapeutic work can be extremely rewarding. Exploring yourself within a non-judgemental environment can feel comforting, it can feel new. Knowing that your experiences aren’t “only in your head”, knowing that they are valid, that they have meaning, can feel like a relief. Understanding how you relate to people, and feeling more understood by the people in your life, can be deeply fulfilling. And realizing that you have some control over how you regulate your mental health, makes the toughest of times slightly more bearable.

I hope this very brief overview of what psychotherapeutic work could look like between you and me, has at least sparked curiosity within you about this process. And it would be an honour for me to accompany you on your journey inward.