Why Does Therapy Work?

It’s not boring to be a psychotherapist. And that's not because, as many clients think, you hear good, juicy stories or view the bones in people’s closets.

It’s sustainably interesting, in part, because it’s enduringly mysterious.

As a therapist, you only have a faint clue as to what’s happening over time, even if you’re committed to a coherent theory and are disciplined and systematic in its application. If your client improves, what you’re achieving is bigger than what’s happening in any given session. It’s complex and multi-layered and it relates to every aspect of the relationship you form with your client, the questions you ask and affirmation you give, and the trust and safety you form. It also relates to the routine, the safety of your office, and the comforting way the light comes through your blinds. And of course, it’s also all about the work your client does in confronting themselves, and the ways they generalize and apply lessons from therapy to other facets of their life.

Various types of long-term, in-depth psychotherapy have a few things in common. They depend on a safe and trusting relationship with a therapist. They follow lived time, meaning life happens during treatment, enabling a client to work and understand in parallel with actual events and changes. They also allow the client to make manifest internalized material, to dredge up and acknowledge thoughts and feelings they may have otherwise just left alone (Drisko, 2004).

Jonathan Lear writes persuasively about what he thinks is happening in the psychotherapeutic relationship. He describes psychotherapy (and in his case psychoanalysis) as a collaborative relationship, in which the participants engage in “thinking-together.” In thinking together the client brings, in depth and over time, the fullest possible sample of her mental content to share and process with her therapist (Lear, 2017).

This sample of thought and emotion is much more comprehensive than the slices we choose to share with our partners or our friends. As clients, we don’t have to filter for social appropriateness or focus on the emotional implications of the disclosure for the other person. Nor do we have to restrict the sample we provide to avoid the perception of self-indulgence or self-importance.

In this unadulterated sharing, we do more than vent or externalize. We provide content that has the potential to lend insight into the very processes by which our mind functions and our actions proceed. We’re able to dive into the workings of our own brain in the most self-aware way.

Lear describes this thinking together as producing, over time, “an unusual practical capacity of mind: the capacity to change the way (one’s) own mind works via the immediate and direct understanding of how it works.”

In some sense, what we’re doing in psychotherapy is studying the machinery of our minds. We’re stepping back, which is a surprisingly rare act, and looking at these inner workings and evaluating things like causality, chains of emotions and thoughts that produce behaviors, emotional triggers, even mistakes or places where the gears get stuck.

Psychotherapy takes these inner workings to be the tools by which we live. Given that our mental processes are themselves the tools, an education in how they work seems indispensable. What would it look like, for example, for the operator of a machine to be utterly ignorant of the mechanisms by which that machine functioned? How could we trust him to operate it to the peak of its capacities?

Lear writes: “Our emotional lives and our desires should not be strangers to us, dominating us through our ignorance, but should be aspects of our lives that we, in one way or another, appreciate and comprehend.”

Lear calls this capacity that we develop in thinking-through together, and in gaining insight into mental functioning, the “the power of mind.” Power of mind is kind of a super power. For one, it’s precious and rare, because the majority of people are walking around with a kind of ignorance about how their thoughts and feelings function. But it’s also powerful in that it allows us to intervene, to challenge thoughts that gum up the works, and to acknowledge and think meaningfully about how to cope with emotions that would otherwise subtly and covertly alter the course of our lives.