Therapy can be like climbing a mountain - hard work but worth the view at the top
Lets face it, therapy is costly! Which begs the question - Is it worth it? Does it actually work? Is a certain style better than others? How do I get the most out of therapy? These are worthy questions to ask before parting with your hard earned dollars.
Many articles I read gave between 3 and as many as 21 tips on getting the most out of therapy. But I think we need to understand the topic in a more meaningful way. So join me for a deep dive on how to succeed at therapy.
A note on Research
Let me spend a moment explaining what I mean about research. I find research perplexing to say the least. For every academic article using science-based research methodology, there are many papers that are not published on the same topic, because the results were not what people or companies wanted to hear.
This can skew our perspectives on the results because we don't get the full picture. Some of the academic literature in the article has included unpublished work.
My research includes academic scientific studies and knowledgable blogs and websites dedicated to mental health research. At the bottom of this article is a list of the sources I
have used if you want to wade through - go for it.
Surprising truth
If you're like me, you’ll want to know the latest counselling techniques, how this technique works, who are the leading practitioners and finally, does it get results. Then I’m down a google hole which results in me wanting to sign up for expensive courses and buying self-help books. Endlessly seeking a silver bullet to fix my woes.
This is effective in that temporarily my problems are gone, while I distract myself with hours in the google pit! But less effective in the long term treatment of the problem.
When I was researching this topic I came across some recent data which grabbed my attention and left me wondering. In terms of therapy, does it achieve what we think works? Is it lining up with what the research says? Apparently not.
I thought successful therapy would depend on the type or school of therapy used, the depth of training and the knowledge a therapist held. Don't get me wrong these are all useful and obviously we all need to be trained, but it turns out to be more than just training and theory. So what was the is the answer?
Quality of Relationship
Therapeutic alliance - is part of the answer. Therapeutic alliance is a fancy way of saying “relationship with your therapist”. Whilst to some this may seem obvious. But if we are distracted by the latest breakthrough therapies, fancy treatment rooms or how many letters are after the therapist name, we are missing the point. The point is you need to have a trusting, respectful and caring relationship with your therapist.
“A little over half of the beneficial effects of therapy accounted for are linked to the quality of the alliance,” according to Dr. Adam Horvath.
This is the single biggest indicator that therapy will work for you.
Choosing a Therapist
When you meet your therapist for the first time
Hold these thoughts in your head:
Will I be able to connect and respect this person
Do they empathise with me
Will I be able to share my deepest, darkest experiences
Do they want to work with me mutually
Will I feel safe enough to address problems within the therapy relationship
How good is your therapist ?
Additionally it doesn’t seem to matter what type of training a therapist has in terms of their ability to be effective. This really surprised me. But totally makes sense.
An effective therapist will:
Actively seek out clients problems
Be skilled at building relationships
Be flexible and open
Work with the client to pinpoint goals
It also appears that the more experience the therapist has, the more skilled they are at building relationships. Over time a therapists develops their ability to form relationships and are better at resolving problems within the therapeutic relationship.
Essentially, when we go to therapy, evaluating how comfortable you feel with your therapist is crucial. Additionally length of experience the therapist has can also impact how skilled they are at creating good relationships with their clients.
Infographic: Emily Darragh 2022
Quality of Participation
The next way to get bang for your buck, has to do with you.
As a therapist I have noticed that clients that succeed in therapy are:
determined
ready to lean into the tough stuff
desperate to make their lives better
ready to put time into practising new skills
curious about how they work
committed to the process
So if you are expecting miracles just because you think your therapist is awesome and you sit on a comfy chair for an hour a week, therapy will not work for you. In other words it means you will need to endure some emotional discomfort and make effort.
Leaning In
Life can feel like wading through a pool of mud. When we lean in, it means to face the uncomfortableness of life. Apart from getting some mud on your face, leaning in is painful and it sucks ,but it produces some compelling results.
At a point in my life I decided that I wanted to be a therapist. This required training, as part of this experience I had many moments of discomfort. I recognised what was lacking in my childhood and pivotal life experience and I relived many painful emotions and memories. This affected me deeply resulting with me sitting in a nice chair for one hour a week alongside a well trusted therapist.
The end result was that I became a better therapist and person because I had experienced the success of leaning in and learning new strategies for coping with life. It also gave me the vital experience of understanding what it is like for my clients facing similar issues.
Its like working out at the gym, building muscle hurts but slowly over time you get stronger and more fit, so when you see the results - its worth it.
leaning in feels very counterintuitive, every part of our psyche wants us to: have a few wines, go shopping, create drama or get super busy. The aim being to distract us from our emotional pain. Being willing to lean in to our pain - leads to better processing of our tumultuous experiences and prepares us to cope better for future ones.
Believe it will work
Another surprising finding in the research was that if you believe that therapy will work - your chances of it being effective increase. One study suggests that even being prescribed anti-depressant medication is more effective if you believe it will work - the placebo effect. Additionaly if you have a trusting relationship with your prescribing Dr then the chances increase again. It is the same working with a therapist, if you are motivated and believe in the power of therapy to affect change and you have a therapist that you trust - it will increase the benefits of therapy.
The Big C
Yes, its that word that some of us fear the most - commitment. Depending on what your reasoning for attending therapy,
committing to the process will help you achieve the desired results.
Sometimes you can resolve an issue in a few sessions. But if you have spent years getting yourself into the current problem, expect to take some time to fix it. Committing to showing up and giving yourself time to work through the Big Stuff is one of the biggest gifts you can give yourself!
Understand that it can take a few attempts at finding a therapist that suits you. Don't be afraid to change therapist if you don't feel the person you are working with is right for you. Undertaking therapy is an investment in your future and your present and it is costly, so it's important to find the right person and commit to the process.
Personality vs Symptom Relief
This is a bit of a gnarly topic.
Apparently, therapy is more likely to be successful with symptom relief rather than personality change. Let me explain - symptoms are the feelings and thoughts we experience when we are struggling such as: anxiety, anger and stress.
Therapy is good at working with symptom relief and will produce results. There are some claims that therapy is not so effective with personality change.
Our personality in clinical terms looks at out thoughts, behaviours, mood and how we relate to others. Looking at personality is a complex undertaking, of which Im not going to do here. But what I will say is that our personality is made up of many different factors: genetics, our environment and pivotal life experiences - resulting in the Shape of our personality.
Personality is the core of who we are and we are born with it to some degree and then we shape it as we age.
Whilst I agree with this to some extent. I believe that, yes you will probably see the quickest results at therapy dealing with symptoms. There are approaches that work with personality and that are really successful. Such as Dialectical Behaviour therapy for working with a person who has Borderline Personality Disorder.
Again it goes back to: find a therapist you trust and being ready to do the work.
Curiosity
One of the main reasons I became a therapist is that I am endlessly curious about how people operate. I also think that is why I like true crime. Why do people do what they do? What are the emotions or lack thereof come from? or sometimes:
What were they thinking?!!
Curiosity for me is a vital ingredient for being an effective therapist. For me being curious demonstrates my energy for wanting to connect with my clients and to learn more about the "how and why" they are here to see me. Curiosity pushes me to seek out the problems, patterns and reasons for stuggle. It paves the way for authentic enquiry into my clients internal world.
Richard Hill states aptly:
A Curiosity Oriented Approach is not a therapy in itself, it is a state of being that shifts the mind, alters the flow of energy and information in the brain, and changes the biology all the way down to gene expression and protein synthesis to produce the biochemical milieu that creates the best conditions for therapeutic progress toward beneficial change.
It is also really useful for you to have a sense of curiosity. According to Faith at Soundwell Music Therapy:
A mindset of curiosity can start opening the door to understanding things about yourself that you don’t yet fully understand. Having a sense of curiosity about yourself and your experience allows you to learn and grow. By being curious, you can recognize patterns and identify ways that allow you to be your authentic self.
According to Richard Hill it seems that curiosity helps to examine meaning and brings purpose and value to the therapeutic process. Beyond the relief of symptoms, bringing meaning to our experiences helps us to understand the broader purpose for these experiences.
Struggling sucks, but if we learn the meaning for them in our lives and they turn out to have purpose and value, I think it makes therapy worthwhile.
If you are reading this and deeply suffering, the concept of curiosity may be something beyond you right now. If I was in the depths of my darkness and someone told me to be curious, you can be sure I would have a few choice words for them!
Don't lose hope
If you are reading this and your thinking Im not motivated enough and Im not sure if I believe in therapy, Im definietly not curious enough. Don't worry too much at the very least you will learn interesting and revealing things about yourself and some new coping skills - at most it could be a transformational life experience.
I probably shouldn't say this, but as a therapist myself, I went through some rough stuff a few years back. I knew I needed some support. But I had developed a deep cynicism about the process.
My thinking was wonky and I thought that: I knew everything that would happen, that I could do it on my own and I didn't want to lean in. I wanted a houseboat - to float away and let my problems dribble out in the wake.
For me making the first appointment to see a therapist was enough to start the process of becoming open to change and reigniting my passion for life.
...Its something about taking the first step that sets the intention in our unconscious mind to move forward...
Anything that’s hard, has ups and downs, and requires you to take it one step at a time.
Alisa Woodruff Therapist
Check out my website if you would like to know more about my practice: www.ngakautherapy.com
or email alisa@ngakautherapy.com
Sources for this article:
DeAngelis, T. (2019). Better relationships with patients lead to better outcomes. Monitor on Psychology, 50(10). https://www.apa.org/monitor/2019/11/ce-corner-relationships
Halverson-Ramos,Faith. (2021), The Role of Curiosity and Acceptance in the Therapy Process, Soundswell Music therapy blog: https://soundwellmusictherapy.com/the-role-of-curiosity-and-acceptance-in-the-therapy-process/
Johnson, Edward (2018)The surprising secret to successful psychotherapy, online publication: Blog: The Conversation University of Manitoba CA
Knobloch-Fedders, Lynne. (2008) The Importance of the Relationship With the Therapist, Clinical Science Insights: Knowledge Families Count On v.1, The Family Institute at Northwestern University. https://www.family-institute.org/behavioral-health-resources/importance-relationship-therapist
Thompson SJ, Bender K, Lantry J, Flynn PM. (2007), Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families. Contemp Fam Ther. https://theconversation.com/the-surprising-secret-to-successful-psychotherapy-104301
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