Getting 'Good' at Therapy

Can someone ‘get good’ at therapy? On the surface, this question might be read as playing into modern day performance obsessions, which should raise a therapeutic eyebrow or two. Surely, therapy contains an invitation to reveal a raw and unskilled self who is encouraged to fumble around in the dimly lit basement of their psyche; clumsily bumping into things and occasionally snagging themselves on a rusty nail or two. I think this analogy holds true up to the point where the person begins to orientate themselves around what they find down there – they begin to become adept at navigating the space, organising it and sometimes even managing to find the light switch. In whatever way the initial time in the ‘basement’ is spent, the person gets incrementally better at the process of fumbling around in the dark. Like doing anything worthwhile in life, the process includes the archetypal becoming from inexperience towards mastery. What happens next can be truly inspiring.

Six years ago, I had a young woman who came to see me for therapy. As with many first-time patients, she arrived at my office full of nerves. After going through some initial interview questions that included what brought her to therapy, as well as what she hoped to get out of sessions, I asked her what it was like to be sitting in front of me. She expressed that she was anxious about perhaps not being able to talk about herself, ‘well enough’. She said, “… ah, I’m ok, I guess … I just worry that I won’t know what to talk about … like, I won’t be good at talking here …”. I reflected, in a light-hearted way, that she was nervous about being ‘good at therapy’ – the interaction produced a sigh and smile before she said, “yes, I know, I know, it’s ridiculous … I just don’t want to waste this time … yes, I’m worried I won’t be good at this”. I think that this interaction was the first real connection in our therapeutic alliance that continued to grow throughout our time together.

I’ve reflected on this experience much since that day. The reason for this reflection has been because of a suspicion I have that what this patient said was actually not ‘ridiculous’ at all. Yes, my initial reflection that contained a hint of her possibly needing affirmation linked to being ‘good’ was accurate; however, she uncovered an important general idea that I (and I think many psychotherapists) might overlook – one can, and does, get good at therapy.

No matter the psychotherapeutic modality, one can think of therapy sessions as a rehearsal for life. It’s during these rehearsals when both patient and therapist unpack the script, investigate dialogue, uncover, and assign feeling to, and re-organise the role. It’s a continuous creative process but one that requires repetition and the integration of new experiences. In fact, I would go so far to say that the longer someone engages in the creative therapeutic process, the better they become at it. ‘Getting good’ at therapy consists of integrating competencies of self-expression and insight that come from the repetitive process – much like any rehearsal or training commitment. And, like any learning process, the better one becomes at something, the more creative one can be with it.   

Any involved psychotherapist knows that the cornerstone change mechanism in any therapy process exists in what the patient or client expresses rather than what the therapist says. As the person articulates more and more of themselves, within the sacred boundaries of the therapy relationship, a universal but subjective organising apparatus seems to take hold. It’s this apparatus that becomes honed and sharpened. It’s a learning process – something someone can get better at. Slowly, things come in to focus and the patient re-organises herself towards self-awareness, and a more consistent tolerance of herself across a wider range of experiences.       

Yes, people can ‘get good’ at therapy, and I generally believe that the better someone becomes at the art of self-articulation, the better the outcomes are. This does not mean, however, that the primary reason to come to therapy is to get good at it. It means that getting good at therapy is the outcome of consistency and commitment to self-exploration. Weekly explorations that contain thought, connection, reflection, and interpretation. As I mentioned above, therapy is akin to most learning processes – it follows the universal arch of beginning as a novice before becoming an expert. This learning arch is embedded in doing anything worthwhile and the project of finding meaning in life is not an easy one to master.

It has been a privilege to watch the young woman who I mentioned earlier develop through her own learning arch over the past two years. She began her therapy journey with fears of not being good at therapy, while avoiding any ‘messy’ articulations and, at times, the therapy process itself – mirroring deeply engrained relationship dynamics. Through the process, she seems to have come to a willingness to express herself in therapy, as well as into her personal relationships, while being able to tolerate herself across a wider field of experience. In other words, she has become markedly more resilient. This resilience, I would say, is an outcome of her getting better at self-articulation within the therapeutic ‘temenos’.        

People come to psychotherapy for a host of reasons – generally because they’re experiencing some sort of disturbance in their themselves ranging from uncomfortable feelings, and the disturbing thoughts that accompany them, to wanting to perform better and to actualise their talents. We know that a well engaged psychotherapy process can produce marked positive change, although not always. There has been much debate for the past 150 years or so about what actually produces this change, how the therapy process works, and why it sometimes doesn’t. These debates stand to reason, as the process of change during therapy could still be considered mystical. How can merely sitting and talking to someone in a room produce the alleviation of some of the most terrifying and disturbing inner experiences that a human being is able to endure? If thought about in this way, therapy is ‘magical’ - it’s just that we, as psychologists (at least those who are thoughtful enough) attempt to explain this ‘magic’ through research or philosophical enquiry that gives meaning to these experiences.

A well-trained, thoughtful, and philosophically aligned therapist will spend much time formulating an understanding of a patient’s experiences. The therapy process will then be focused on encouraging the patient to articulate themselves through these understandings, while being very careful not to intrude too much into those self-expressions. As the therapy unfolds, the person begins to understand the multiple reasons for how they have arrived at this point, as well as what their contribution to their own life is. This unfolding takes time. It also requires a tremendous amount of interest, patience, and listening skills on the part of the therapist, hence, the time and difficulty required of psychological training – something, I fear, is being lost to our current ‘mental health’ custodians. 

In conclusion to this short piece of opinion, I believe that the positive changes associated with a committed and consistent therapy process have far more to do with what the patient says, feels, and generally experiences rather than what I say or do throughout the sessions. In fact, I’m convinced that my role in the therapy space is to create a consistent environment that is trustworthy enough for the patient/client to continue to express themselves – my role as an information provider is almost irrelevant when compared to the patient’s or client’s expressive contributions. When an individual experiences a consistent space amenable to self-expression, a re-organising principle seems to take hold. Through experiencing, thinking, articulating, and receiving feedback, the patient appears to begin to re-organise herself towards a self that is aligned with the reality in which she exists. It is the patient’s voice that must take up the therapy space, not the therapist’s. I’ll go even further to say that I’m of the opinion that anything I might contribute to the therapy session should be directed towards encouraging more expression from the patient. I think that this is what Carl Rogers was describing when he outlined his ‘basic’ but potent ingredients (core conditions) for therapeutic change – congruence, unconditional positive regard, and empathy. These are the core principles that not only scaffold the becoming of an individual but that also support the patient’s learning arch to becoming ‘good at therapy’.