How does therapy work?
You’ve likely seen therapy portrayed in a variety of ways, from characters on TV being a patient or providing treatment, to reading or hearing about someone else’s experience with therapy, or through your own research trying to figure out what exactly happens when you begin therapy.
A tricky thing with therapy that isn’t always well known, is that there are different theories and modalities that therapists adhere to. Some put more emphasis on your thoughts, some on your behaviors, others on your emotions, and some a combination of all three. My specific modality is psychodynamic, so I will be speaking to that modality because I am most comfortable and knowledgeable on this one.
Logistically speaking, the first sessions are about obtaining background information and understanding what events led to you reaching out to begin therapy. Once we cover the background information there are several areas that I focus on as a therapist:
Patterns: While we are talking and interacting, part of my mind is logging what you are saying and attempting to track and identify any persistent patterns that come up. This could look like persistent emotions that you are avoiding, common interpersonal interactions you find yourself in, or common responses to certain emotions that you experience. There are a variety of different patterns that may present themselves, and once a pattern does present I then work with you to figure out the formation and function of this pattern. Is this pattern one you are aware of? Is this pattern something you want to continue engaging in? If not, what things are causing you to continue with this pattern that we can address?
Awareness: While listening to you and processing with you, a goal of mine is to increase your awareness. This could mean awareness of your emotional experiences, awareness of your interactions with certain emotions, awareness of common interpersonal patterns you engage in, etc. Psychodynamic therapy believes that healing can come when we bring things from our unconscious to our conscious awareness. It is not uncommon that we engage in things without fully being aware of why we are doing them. By bringing awareness to certain aspects of your experience, it allows you to have more say and control over what you do.
Integration: It is not uncommon that through our processing we jump back and explore your childhood and early attachments. While it may seem that these years of your life would have no effect on your current experiences, that is often not the case. Through this exploration of your early attachments, we can start to gain an understanding of your “childhood self.” Through our processing together we may end up exploring different parts of your self, such as your childhood self, your adult self, and other identified parts of self. Sometimes, people come to therapy when these parts become disintegrated and are in conflict. For example, your childhood self feels safer in isolation due to childhood abuse but your adult self is seeking and craving an intimate relationship. The conflict between these two parts of self has led to a string of unsuccessful relationships but you can’t pinpoint why these relationships keep failing. Part of our therapy would be addressing this childhood self who feels unsafe in relationships and working towards better integration of the various parts of self.
Ego strength: You may have heard of Freud’s id, ego, and superego. If not, the id is the more primitive and instinctual part of the self, the superego is the moral consciousness, and the ego is the part that mediates between the two. Part of our work together may be strengthening your ego functioning. A common effect of abuse is that a person may lean more heavily toward their id or toward their superego. This can present as a person who has difficulties with impulse control and delayed gratification or a person who is stuck in rigidity and seriousness. The goal here is similar to integration, it’s to find a better balance and work towards resolving the conflict the id and superego can have resulting in you having more control and say versus feeling like you do things but don’t know why.
Each client’s path takes a unique route. But, these are common things that tend to come up in one way or another due to my practicing from a psychodynamic perspective. If you find yourself on the search for a therapist, it’s always an appropriate question to ask the therapist how they conceptualize their work to see if you think the therapist would be a good fit. And, if you’ve had a bad experience with a therapist, there’s a good chance that the theory they practiced may not have been a good fit so I encourage you to explore therapists from other modalities and give it another shot.
