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How Psychotherapy Works

Updated on June 2, 2008

Getting the Most from Psychotherapy

by Helen Borel, Ph.D.

For most people, the psychotherapeutic process is shrouded in mystery, seeming to emanate from an occult realm of uncertainty, of unseen happenings - as well as from the wild theories of erudite analytic practitioners. The latter, who are, too often, elevated to a status, in suffering patients' eyes, beyond what they are actually able to accomplish with their patients' real current symptoms, interpersonal needs, and future goals in mind.

Fantastical or leadenly boring depictions of therapy sessions, in films and on television, do little to help viewers grasp what really occurs on many levels for patients in actual therapy.

Your Initial Expectations

So patients seeking emotional treatment often attribute to the analyst or therapist certain magical powers that can swiftly wipe away the tears of grief, immediately lift the down mood of a years-long depression, disappear - finger-snappingly - all anxiety attacks, rapidly materialize a fabulous career, and absolutely guarantee a quality love relationship in a heartbeat.

Examine Your True Needs

There are many good reasons to enter into psychotherapy. These include:

. Severe mental illness, such as the psychoses of schizophrenia

. The mania and depressive phases of bipolar disorder

. Delusional states such as paranoia

. Chronic dysphoria (low mood state)

. Insomnia

. Writer's block or Career stagnation

. Social inhibitions

. Relationship problems

. Childhood abuse...sexual, verbal, emotional neglect, physical assault

. Job loss

. Grief

. Unrelenting sadness

. Depression

. Anxiety or Panic Attacks

. Alcohol or Drug addiction

. Spousal battery

. Exploring and Expanding One's Creativity

The Reality of the Process

Think of your psychotherapist's space as an ICU (Intensive Care Unit) where nearly every aspect of your being is being monitored - by both you and your therapist. Where minute-by-minute shifts in your intrapsychic condition are being recognized, recorded and swiftly addressed and attended to. Where healing ensues at a pace each patient's condition can best tolerate.

I use the ICU, as the prototype here, to also emphasize my particular concept of the "immediacy perspective" from which therapists must view their patients' emotional needs and the urgency of grappling with these sufferings in each session, as they arise. Just as in the ICU, vitals are monitored, some occurrences are anticipated with treatments at the ready, and other signs and symptoms are observed and treated with haste, as they arise. All geared toward healing of the acute condition, preventing chronicity, and saving a life.

My Therapeutic Philosophy is Based on My "Urgency" Model

Except for certain not-too-common conditions, where virtually life-long supportive therapy is required to keep certain personalities...such as borderlines...on a relatively even keel, most psychotherapy patients benefit from a process that gets their lives moving in healthy directions as swiftly as they are motivated to participate in such Self evolution.

In other words, being "in therapy" for decades with minimal-to-thuddingly slow emergence from pathologic states of emotional suffering, career blockades and relationship failures is a tragic waste of your time, your money, and your life.

The Multi-Stratified Therapeutic Process

Therefore, I see this process as an emergency that must be handled, yes with skill and compassion, but as expeditiously as possible as the patient's tolerance for Self-change will permit. With this foundation in mind, be aware that your treatment and healing processes take place on many levels simultaneously - within you and in your relationships and activities in your outside world.

In sessions, realizations ("aha" moments) happen often and crying sometimes pours forth. Out in the "real" world, difficult family members are better dealt with, destructive "love" relationships are dropped, toxic "friends" are gotten rid of, career options open up and are widely expanded, and depressive and anxious states are modulated or eradicated.

What Else You Should Really Expect from Your Therapy

An "objective," what I consider an "aloof," professional appears to me to be too removed (and feeling too superior to the patient) to be of the fullest help possible to you. This supposed "objectivity" may be due to certain stiff personal traits of such therapists, coupled with a stubborn adherence to academic theories with little flexibility or imagination to go out on an emotional and creative limb in the patient's behalf.

The most valuable psychotherapy, I believe, comes from a healthy mix of creativity, psychological risk-taking, intuitive interactions, and compassionate feedback interventions - all emanating from your therapist's subjective perspective that nearly equalizes the status of therapist and patient.

To be more precise, this kind of highly-involved therapist is working in the very sensitive area of intersubjectivity - where both your deepest Self, its images, experiences, concerns and your therapist's deepest Self are interacting in the most dynamic ways to your greatest benefit.

Much is accomplished in patients' lives using these skills, talents and other behavioral tools to positively impact patients' emotional growth, relationship interactions, work lives, and overall life happiness.

Some of the processes that go on in your "therapy sanctuary" (the confidential, empathic space you share with your therapist during sessions - and that you often visualize mentally, in feeling states between sessions) include:

(1) free association (saying everything that comes to mind without editing anything out), (2) dream reporting and interpretation, (3) revisiting painful childhood happenings and learning new ways to cope with these memories, (4) working on specific and current relationship and career problems, (5)learning ways to know your real Self more fully and clearly, (6) being guided in specific techniques, thought process controls and newer behaviors that will assure you're more likely to get what you want out of your life - instead of being mired in uncertainty, timidity, anxiety, sadness, creativity blockades and loneliness.

Your high quality psychotherapist helps you in many ways by taking on multiple roles - either proactively, or that you the patient assign to her knowingly or unconsciously - based on your particular needs at various times or phases in your psychotherapy process.

She may seem like a parent, an instructor, a guide, an archeologist (helping you dig into your past), a magic dream interpretator, a relationship arbiter, a friend, a sister, a confidante, a grandparent, a rescuer, a career counselor, a minister. Whatever your imminent state of being requires, your caring psychotherapist easily slips into these roles in order to help you, interactively, deal adaptively with problems that can be handled in no other way and by no other means outside of this, your therapeutic "holding" environment.

Your Role in You Therapy Process

So, now you know some of what to expect in therapy from your therapist. In a companion article, "Participating Wholeheartedly in Your Psychotherapy," I'll discuss the things you can do to enrich your therapeutic experiences and interactions with your therapist. Because, when you both take your very Self seriously, with the same determined focus on your overall well-being, this therapeutic alliance will be so strong that, feeling fully supported, you are bound to take exponential leaps forward in your emotional and creative growth.

I invite you to visit to read my other articles on Alcohol Dependence, Social Anxiety Disorder, and Insomnia. Soon to come at this site: "Are there Advantages to Madness? Part I PSYCHOSIS" and "Are there Advantages to Madness? Part II ANGER".

To learn more about all other mental health issues and psychotherapy, write to me at:


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