How does therapy work?

Therapy is mysterious to the uninitiated. Do I lie down on a couch like cartoons of Freud? Will I have to talk about my mother a lot?  The truth is, there are three main elements of good therapy: catharsis or emotional release, a trained external perspective, and skills training. Theories of counseling vary in their emphasis and inclusion of other processes, but most of them agree on the importance of these three.

Catharsis is the process of talking through emotionally charged material.  In my last post I discussed James Pennebaker’s research on the necessity of self-disclosure and resulting catharsis.  In other words, talking about your feelings is not just self-indulgent whining. Saying out loud what’s dying to get out of you is crucial for your health. If you have a place where you’re free to express lingering thoughts and emotions, it leaves you free to focus on other things in the rest of your life. Therapy provides a context in which catharsis is unambiguously appropriate.

A trained perspective can shine a new light on your problems by illuminating opportunities for exploration and change.  A mental health professional has been taught to recognize recurring problems with emotions and relationships, as well as possible solutions.  I believe one of my duties is to always be reading, researching, and training so that I have more options to offer my clients. A professional can also offer unbiased feedback and hold you accountable as to whether you’re living in a manner consistent with your values and goals.  

A therapist coaches you in skills so that you can intervene in your own self-defeating patterns of thought or behavior.  Skills training can be very structured: for example, therapists specializing in mindfulness can offer specific meditative techniques and thought experiments that train you in acceptance. Cognitive-behavioral therapy (CBT) therapists coach you to use structured exercises that challenge negative thought patterns. Broader relational skills can also be built using the counseling relationship as laboratory. You might practice and get feedback on being assertive or expressing healthy anger towards your therapist, either in reaction to a real life issue or as a role-play.

Catharsis, perspective, and skill building form the launchpad of a successful therapy relationship.  Your therapist should be able to offer you each of these elements with their own personal touch. And now that you’ve read this article, you have more vocabulary to think about and can ask for the blend that will best help you.