How does therapy work? Understanding the therapeutic process

Going to therapy, either for the very first time or returning to receive further life support, can be really daunting.

It can feel like a mysterious process, and given that most of the literature can be quite difficult to understand, it can feel like a disempowering process where therapy is ‘happening’ to you.

So what actually happens in therapy?

Well… how the therapy looks can be different depending on the modality of the therapist. Which ‘maps’ they are using to understand and frame your experiences.

And the modality will also determine which ‘tools’ the therapist uses. For example, an art therapist will use art and creativity, a CBT therapist will work with thoughts and behaviours, and a Gestalt therapist may use the empty chair exercise.

While approaches vary, many forms of therapy involve the therapist listening carefully to your inner world and working to understand you. Then, to help you to understand yourself, your experiences and your feelings, by reflecting what they see. This understanding, within a safe and empathic environment, can be an important part of therapeutic change. The therapist is there as a guide.

To walk alongside you as the client, through your self-discovery and to support you with the areas of your life that need you - perhaps to build self-esteem, perhaps to build self-love, perhaps to build boundaries, or to help you process anger or to sit alongside you in grief.

What happens during the therapeutic process?

Understanding anxiety may be part of your process, and the therapist will bring in their ‘tools’ to help you learn to manage in your everyday life. At the same time, psychotherapy may help you explore some of the experiences, thoughts or patterns that could be contributing to your anxiety.

At a deeper level, if relationship experiences are contributing to your anxiety, the therapeutic relationship may also provide an opportunity to experience a kind, caring and accepting relationship with another.

Perhaps you are feeling depressed.

Again, there are ‘tools’ that can help you to manage your life that your therapy can teach you. Therapy can also help you explore what may be contributing to how you’re feeling and how your experiences may be affecting you today.

For some people, depression may be experienced partly as a way of withdrawing from or protecting themselves from difficult feelings which they haven’t felt safe enough to feel and share. By sharing in an empathic space and building trust that someone cares, you may be attending to not only the feelings but also fears that people can’t be trusted. And hopefully questioning those fears and learning something new. Perhaps you may learn that there are people who can be trusted.

So you can see that there can be many layers of change taking place in therapy.

You may be learning tools to manage, developing a greater understanding of yourself and exploring how you came to be who you are. You may begin to work through some of the difficulties that brought you to therapy.

At a deeper level, you may begin to change some of the blueprints of how you have come to view the world and what it has to offer you, particularly in relationships. This is the beauty of being human. We are not set in stone. Our capacity for learning and change means that patterns of thinking, feeling and relating do not necessarily have to remain fixed.

Your role in therapy

To understand that the process is happening between both the therapist and the client can be empowering to both. The therapist’s role is to hold the boundaries and support the client. The client's role is to participate in the process at a pace that feels manageable and to raise questions or concerns about the therapy when they arise.

In trauma-informed work, the therapist may be more directional to help manage the pace of the work, as the client may have developed ways of coping with overwhelm or numbness that once helped them but may now be causing difficulties. Careful pacing can be an important part of the process, supporting the client to develop different ways of managing. However, if the process is shared with the client, it should include them so they feel involved and empowered.

Understanding the process can help the client feel like a change agent in their own life.

Of course, to name everything that happens in therapy is impossible in one short article. However, the essential stuff of the therapeutic space is this: to be heard, seen, challenged, empowered and, most of all, to be working towards change.

Not as a patient where something is happening to you, but as a client, where you may not know exactly what’s going on but you feel involved and informed enough to show up each session with trust in the science and the magic that can occur between two human beings.