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So you’ve never been to see a therapist but you’re considering it. How does therapy work?

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By Arnab Datta, MD 
Published on Feb 29, 2024

First and foremost, we can talk to a therapist about our emotional problems. It may feel good to vent to a therapist when we don’t feel comfortable venting to friends or family. As much as friends and family want to help, sometimes they can get overwhelmed with this heavy emotional information. Maybe we’re not comfortable telling friends or family about our negative traits or struggles.

One of the beauties of therapy is that we can vent. However, therapy is more than venting. It’s more than receiving a reality check. Therapy can be many things. Freudian psychoanalytic therapy is very reflective, and the therapist reflects our concerns back to us so that we find our own answers. Psychodynamic psychotherapy is more conversational, but the conscious and unconscious minds are assessed. It takes a deep dive into our personalities. Cognitive-behavioral therapy (CBT) is a goal-oriented therapy that uncovers unconscious ways of how we’re getting in our way while also moving towards a goal. Therapy is also about receiving objective feedback about why we are the way we are. At its most fundamental level, therapy is about receiving emotional support. We must ask our therapist what their psychotherapeutic style is, so we’re not surprised. It may not work in one session; one may need to come back once a week for some time, or six months at least, hypothetically speaking.

Therapists can take three or more sessions to get to know us before any deep interpretations are provided. An interpretation from a therapist means they uncover deep psychological concepts about why we are the way we are. It may be an observation that we may or may not already know. It takes time for patients to feel comfortable telling the therapist their true story in its entirety. It’s a learning curve on both sides.

One should ask their therapist specific questions about their philosophy of psychotherapy because all therapists work differently. Some therapists do not give advice. This is because they believe that unsolicited advice is not appreciated, and solicited advice is almost never appreciated; this is actually a common concept in human nature. It doesn’t make the therapist or people bad or insensitive; it’s just tactful and cautious. Here’s a controversial topic: It’s difficult to find a therapist who will tactfully tell us how we’re getting in our way. This is because therapists are first taught to be supportive and build self-esteem. However, what should we do when we are living in a fantasy world in our minds? Is a therapist supposed to support that? That’s where the skill, empathy, and courage of the therapist and the quality of the relationship come into play. For the therapist to challenge the patient in their fantasy world. This has caused friction in the therapeutic relationship between patient and therapist, but it’s for the betterment of the patient. 

Therapists used to say that if the patient has changed a little in 3 years, then the therapy has been effective. If patients realize what they are doing unconsciously in 3 years, then the therapy has been effective.

Today, most people don’t have that kind of time. Today, if our behavior has changed in 9 months to a year with weekly therapy, then we have done well. It’s a controversial topic. Who says how fast we need to improve? Different people have different expectations. It comes down to the relationship we have with ourselves and with our therapist. Patients who take therapy seriously and do their homework or who work on changing their maladaptive behaviors in between their sessions may change in 6 months if they’re dedicated. 

That’s how long it takes to change one’s psychology and behavior. It only works when the patient is dedicated, consistent, and desires to change from within. Basically, if therapy is easy, then we’re not doing it right. It’s like a workout for one’s heart and mind. However, some patients go to vent their frustrations, and that can feel pretty good. If someone quits therapy after 3 months, they haven’t really done anything. If a therapist gives direct, objective feedback, we may have received it, but it’s still going to take time to apply it in our lives. It’s going to take some time to intellectualize that advice in our heads before we actually feel the behavioral change in our hearts. This head-to-heart thing takes time. We have to work on it every day, or pretty often, to feel that behavioral change is second nature.

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