How do counselling and psychotherapy work?

The great news is that therapy does work, and works well. Research has demonstrated that the average person who has received treatment is better off at the end of therapy than 80% of those who haven’t yet entered therapy (Lambert & Ogles, 2004, Wampold, 2007). Increasingly, research is also telling us how therapy works and what we need to be doing in our sessions to make therapy most effective.

Most of us struggle with difficulties at some point in life. Very often we are unaware of the deeper, underlying causes of our problems - we just know that things aren’t working for us; we’re suffering. What we discover in therapy is that many of our problems are the result of outdated coping mechanisms, deeply rooted in emotional learnings from the past.

All of us learn various coping strategies for dealing with the world from an early age. We learn from what we’re taught, but also from what we experience. The problem comes when the lessons learned in past situations don’t work so well in the present. We then behave automatically based on emotional experiences from the past, when the present situation actually requires a different response. These outdated coping strategies then start to cause us problems, leaving us less adaptable to different situations, and sometimes causing the very opposite of what we want. 

Neuroscience now shows us that experiences involving strong emotion leave a particularly strong impression on our brains (Milner, Squire & Kandel, 1998; Roediger & Craik, 1989; Siegel, 1999; Toomey & Ecker, 2007; van der Kolk, 1996). The lessons learned in these emotionally charged situations become the source of our habitual patterns of behaviour when facing similar situations. We respond automatically in these situations based on the original learning, usually without even being aware of the original implicit learning (Ecker, Ticic & Hulley, 2012, McGaugh 1989, McGaugh & Roozendaal, 2002, Roozendaal, McEwan & Chattarji, 2009). Thankfully, due to neuroplasticity – that is, the life-long changeability of the brain – we now know that the old learning can be erased completely and replaced by new learning, leading to new, more helpful responses to life’s situations. What’s required for this process to occur is a new emotional experience to imprint new lessons on the brain. When this happens, the old symptoms fall away, freeing a person’s potential to live life fully (Ecker, Ticke & Hulley, 2012).

This is what the deep work of emotionally engaged therapy achieves. Therapists practising this approach will work with their clients to explore their problems deeply, so they can discover the original emotional learning that is at the root of the problems and then work through all the feelings involved to provide them with the new emotional experience required for their symptoms to fall away, and their true potential to be freed.


Ecker, Ticic, Hulley (2012) Unlocking the Emotional Brain: Eliminating Symptoms at their Roots Using Memory Reconsolidation. London: Routledge.

Lambert & Ogles (2004). The Efficacy & Effectiveness of Psychotherapy. In Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy & Behaviour Change. New York: Wiley.

McGaugh (1989) Involvement of Hormonal and Neuromodulatory Systems in the Regulation of Memory Storage. Annual Review of Neuroscience, 2, 255-287.

McGaugh & Roozendaal, (2002) Role of Adrenal Stress Hormones in Forming Lasting Memories in the Brain. Current Opinions in Neurobiology, 12, 205-210

Milner, Squire & Kandel. (1998) Cognitive Neuroscience and the Study of Memory. Neuron, 20, 445-468

Roediger& Craik (Eds) (1989) Varieties of Memory and Consciousness. London: Psychology Press.

Roozendaal, McEwan & Chattarji (2009) Stress, Memory and the Amygdala. Nature Reviews Neuroscience, 10.423-433

Siegel (1999) The Developing Mind: Toward a Neurobiology of Interpersonal Experience. New York: Guilford Press

Toomey & Ecker (2007) Of Neurons and Knowings: Constructivism, Coherence Psychology and their Neurodynamic Substrates. Journal of Constructivist Psychology, 20 201-245

van der Kolk (1996) Trauma and Memory. In van der Kolk, Mc Farlane, Weisaeth (Eds.) Traumatic Stress: The effects of overwhelming experience on mind, body and society. New York: Guilford Press.

Wampold (2007). Psychotherapy: The Humanistic & Effective Treatment. American Psychologist, 62, 857-873

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