Demystifying Therapy - What's It Like and How Long Does it Last?

I am often asked these questions by clients who want to visit me - two people have done already this week.  I thought I’d talk generally about the work of a counsellor and what tends to happen in my Practise.

More and more people are going to counsellors now and I find that it’s much more usual for people to speak about it in social situations.  If I am in a pub, for instance, and people find out that I am a counsellor, there is normally huge interest and I often get folks telling me that they’ve seen a counsellor or would like to come and see me to tell me about their problems.

So how does therapy work?  Well, in my Practise the journey of therapy is often very different for each client.  Experience has shown me that the famous therapist Irvin Yalom was right when he said that one must “invent a new therapy for each client.”  We all have our own story to tell and what I would work through with one client may not be appropriate for another.

The sort of therapy I do is humanistic, mainly person-centred, so I respect that the client is the expert in their own life.  They know more about their lives and problems than I do, so I act as a guide and facilitator to them  - listening to them,  trying to make things clearer and in focus and trying to help them remove barriers in their life and to look at their options.  I work to form a warm, empathic, honest, confidential, trusting and understanding relationship with them.  I look at what is happening to their body, mind and emotions as they tell their story.  But although, as I stressed earlier, we are all individuals, there is another side to this - human beings the world over tend to suffer from similar problems – we are not always all so different as we like to think we are, or as the Roman dramatist Terence put it: “I am a human being, so nothing human is foreign to me.” There tend to be certain issues that crop up a lot and it’s part of my training to spot and help with those.  There are, of course, patterns and this is what I’m mainly going to look at next.

I rather like the idea of Milton Erickson that “therapy is often a matter of tipping the first domino.” Sometimes a client does not really know what his or her chief problem is and often the first problem that they tell you about (known as “the presenting problem”) is not the deeper problem that they have.  Sometimes it takes many session of talking and working through things before something clicks – that first domino falls and then the rest of therapy can be a relatively straighter path – I say “relatively” because nothing is ever straight forward with us complex human beings and often the business of the client’s week must take precedence over any longer term business.   

All of this means that often the first thing that is required for change is AWARENESS.  It is normal for people to become more aware of what is going on in their lives and what they’d like to change during therapy.  After that comes ACCEPTANCE.  As Carl Rogers, the originator of person-centred therapy states, “in order to change I must first accept myself as I am.”  More often than not that acceptance is for something positive and good that someone has been denying to themselves or avoiding.  After acceptance comes CHANGE – and part of therapy is to talk about ways that can happen and what it might be.

The main things that people are having issues with these days tend to be self-esteem issues, anger, depression, and work and relationship concerns.  Often, but not exclusively, these boil down to one of four existential issues that each of us inevitably faces at one time or another – loss, meaninglessness, isolation, freedom vs responsibility.  Sometimes the client knows this from the start of therapy; sometimes one of those issues is almost immediately apparent to me, even if it isn’t to them; sometimes the client is aware of the issue but cannot define or pin it down and we discover it together; sometimes it takes a lot of work to get to the root of something - but it almost always comes.  It’s inevitable that each of us has blind spots about our own lives and personalities and that illumination is also part of what happens in therapy.

One of my recent clients summed up what happened to him in his counselling by giving me this feedback – “I had some painful self-esteem issues and I wasn’t happy.  I wasn’t really sure what was beneath all of this though I had some ideas and clues. You listened to me carefully and I feel you’ve helped me work on things so that I now feel happier with my life and am more confident about moving forward.”

In terms of time, I have had clients – both individuals and couples for whom one meeting was enough and some I saw for over 40 sessions.  It really does depend.  I often recommend to clients that they come for at least 6 sessions as this is about the time it takes to build up the therapeutic relationship to a state of trust and depth where issues start to come out. 

I go with the client’s own speed and needs as to whether and how we move from immediate issues to exploring something deeper and more underlying.  I don’t push someone quicker than they want to go, but that doesn’t mean I am not challenging – if a client is in denial about something or avoiding an issue then part of my role is to find the right moment to explore that.  Often, it’s those deeper matters that require the most hard work but which are ultimately the most rewarding.  That’s not surprising since the aim of therapy is often to enable people to have a more comfortable relationship with themselves, the world and other people around them.