Why Psychotherapy Works
Updated: Apr 7, 2021
Does talking about your problems really make you feel better and improve your life?
Psychotherapy is a general term for psychological therapies that involve talking openly with a trained mental health professional about your life challenges, moods, feelings and behaviours. While many people benefit from psychotherapy, the sceptical among us may question the rationale behind therapy as an antidote for mental and emotional distress. “How exactly is paying someone to listen to me talk about myself and my troubles really going make me feel better?” you ask.
“How exactly is paying someone to listen to me talk about myself and my troubles really going make me feel better?”
Well, you’re not alone. As a teenager, at the behest of my very worried parents, I saw a variety of mental health professionals (I saw more than one because I was a very sceptical and uncooperative client who a number of therapists no longer wished to see), and I too wondered how talking to a therapist was going to be of any real use to me. Many years and many therapists later, I look back at my journey in treatment and realised that psychotherapy had changed me for the better, without me even being aware of it. Over the course of twelve years, I had worked with three therapists – a psychiatrist, a hypnotist, and a cognitive behavioural psychologist – who helped me a great deal. Through the provision of their safe, nurturing and non-judgement presence, they gave me the space I needed to work through old traumas, let go of destructive attitudes and habits, and find new, helpful ways of dealing with my troubles. When I realised the magnitude of change that occurred in my life, I felt immensely grateful for the help I had received from these three therapists. I became curious about the mechanics behind the therapeutic process and decided to study psychology and cognitive behavioural hypnotherapy.
Here are three reasons why psychotherapy works.
The Therapeutic Alliance
Carl Rogers, the founder of humanistic psychology said that a therapeutic alliance between the client and the therapist is the most important factor in determining the efficacy of treatment. According to Rogers, a good therapist is empathetic, a good therapist is congruent – meaning, they are genuine and not phoney or pretentious –, and most importantly they have what Rogers refers to as “unconditional positive regards” for their clients.
During my time as a client with the three helpful therapists I had mentioned earlier, I had experienced this unconditional positive regards. But this quality was not about the therapist being agreeable or even “likeable”. I felt unconditional positive regard from these therapists because even when I told them unpleasant things about myself, or even when they told me things I did not wish to hear, I still knew that they had my best interest at heart. I sensed that I was not being judged and that I was in the company of a person who accepted me even when they did not condone my maladaptive thinking or behavioural habits.
Once a therapeutic alliance is established, the client knows that their therapist is trustworthy, and they feel understood and unconditionally accepted for who they are. The social dynamics of such an interaction is rare and powerful. Such an alliance provides a physically and emotionally safe relational space where the client can then allow themselves to be vulnerable enough to look deeply at problems that they are unable to safely look at in their day-to-day lives. Within this space, the client can then safely explore new ways of approaching their problems and reacting to challenging situations.
Setting and Achieving Goals
Rogers also explained the importance of goals in therapy. A therapy session is not the same as a chat with a bosom buddy because the role of the therapist is to help their client to define, stick with, and hopefully achieve their goals. Throughout treatment, the therapist’s job is to gently guide their client’s attention to the areas in their lives where they have agreed that changes need to be made.
The therapist and the client should both agree on what their goals are early in the session. Goals can be broad, for example: “I want to be more motivated” or “I want to feel less depressed”, or it can be more specific “I want to be able to change careers by the end of the year”, “I want to not argue as much as I do with my parents” or “I want to stop smoking”.
Therapy should not go on indefinitely, because a good therapist aims to equip their client with the skills they’ll need to eventually cope with their challenges on their own. Goal setting in therapy gives clients a self of autonomy and agency, so they do not feel dependent on the therapist but empowered to take control of their own mental health and to continue improving their lives long after therapy is over.
Learning and Modelling
In his studies on children and how they learn, Soviet developmental psychologist Lev Vygotsky came up with the theory of Zone Proximal Development (ZPD). ZPD refers to a range of skills that a child is able to perform with assistance and supervision but is as yet unable to perform on their own. Vygotsky found that when in isolation, children exhibited one level of competence on a task, but when the child was being guided by another person, he or she exhibited a higher level of competence on the same task.
The ZPD theory applies to adults too. Have you noticed that sometimes, no matter how much you want like to change a behaviour or way of thinking, you simply cannot do so despite your best intentions. For example, you may lose your temper more than you’d like in certain situations even though you would prefer to remain calm and collected. Or you might not be able to stop smoking even though you know it’s making you sick. If we have someone to talk us through things when we’re learning new cognitions and behaviours, we have a better chance of success than if we attempted to engage in the new thought or behaviour independently and experienced repeated failure. Thus, the therapist serves as a teacher and guide, enabling us to rehearse new, healthy cognitions and behaviours in a way that will also increase our confidence in our ability to enact these thoughts and actions outside the therapy room.
Because therapists have received professional training and abide by the ethical codes of the mental health profession, they also know how to set appropriate relational boundaries and manage their emotions within the context of a therapy session. By monitoring their own language and emotional responses in a session, they serve as good role models for their clients to emulate. By watching the therapist, clients can learn about healthy social engagement through observation and imitation.
Indeed, psychotherapy offers many benefits to an individual looking to make positive changes in their lives. However, no matter how competent the therapist is, therapy will not work without the client's efforts. I know that because I started out as a cynical, unwilling and uncooperative client. But over the years, psychotherapy worked its magic on me and I hope to share some of this magic with you.