How Therapy Works (Sometimes)

(Originally posted on drjacobham.com)

herapy is such an interesting, magical thing and there are so many ways that it can help and for such a variety of issues. It's honestly hard to describe what makes it work, and I think most therapists would struggle to summarize an answer. I’ll give my favorite answer to how therapy works, recognizing that it’s definitely not the only answer.

Therapy helps people heal interpersonal wounds and build trust and love with other people and more importantly with themselves

Most people who seek therapy struggle in their relationships with others and this struggle often reveals struggles in people’s relationships to themselves, which in turn is often reciprocally due to earlier problems in their relationships to primary caretakers. It’s as if all relationships at every interpersonal and intrapsychic level are literally fractal--that is, they echo each other at different scales of experience. Even a person’s relationship to their therapist echoes this core, fractal pattern of relating. I personally enjoy working in this way and pay careful attention to my experience in the room with another person and the moment-to-moment nuances in our interactions. I trust that what happens in the moment is a fractal of the core issue, so exploring and healing the moment will heal relationships that expand out into the real world and pierce inwards towards one’s relationship to the imagined “Others” in one’s heart and to one’s relationship to oneself.

I find that this careful, attentive listening works really well when working to heal all types of family relationships too. This approach seems to help people get out of the rut of having the same fights over and over again. Most family fights happen because people are too afraid to speak from the true place of vulnerability and hurt. Instead, they lash out and attack back when they feel they’ve been attacked. People also have a hard time acknowledging and listening to each other, desperate to make sure their own voices don’t become diminished or drowned. At other times, ghosts of relationships past, self-hate and self-criticism haunt us and distort everything we hear into the messages we most fear hearing. For instance, we hear “I wish you wouldn’t do that” as “I think you’re stupid and disgusting.” Or, more commonly, we hear  “I’m tired of fighting with you” as “I hate you and I’m leaving you,” which scares the heck out of all of us!

If my approach doesn’t fit with you, that’s okay. I think the fractal nature of  experience means that many kinds of therapy can heal because the healing has a ripple effect across the levels of experience. For example, a cognitive therapist might focus on uncovering and challenging destructive core beliefs about oneself or others; a behaviorist might focus on coaching specific ways to change one’s behaviors in real relationships outside the therapy room; or a psychoanalyst might explore childhood history and/or its impact on the here and now of the therapeutic relationship.

So, the most important thing to consider when finding a therapist is not what type of therapy they practice, but how they make you feel when you talk to them. All consumers of therapy know this implicitly and act on this knowing by either showing up every week or missing appointments and avoiding therapy (I wish that more of clients would express their dissatisfaction with verbal feedback, instead, so therapists can learn and become better therapists).

There is such an incredible amount of hurt that flows like a deluge across the world. It crashes through us one interaction at a time as we are hurt and then hurt the next in return. The only way to stem the tide is to actively and defiantly say “I will no longer allow this hurt to pass through me and poison me.” Then, this commitment needs to be made again and again, because the tide of hurt is big and deep. It wells around us and springs from us. But, someday, the momentum can change, such that being light becomes a little more easy, less work. I promise. Be patient. In fact, that patience is one of the first and most important acts of love and light that stems the tide.