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Behind the Couch

Therapy is my profession and I find people both fascinating and complicated. Some may feel hesitant to enter counseling because of their unfamiliarity with the process. What goes on in a therapy session? The process may vary depending on the type of help solicited (psychologist, psychiatrist, mental health counselor, nurse practitioner etc.) but the goal of improving mental health is the same. To begin with, it is essential that the patient feel comfortable and trust the provider's intentions. Sometimes, personalities do not mesh well or the patient discovers they would rather confide in a male or female counselor. If the trust relationship does not happen, it is time to move on to a new provider. Once trust is established, life change is possible.

In essence, when someone comes into my office, the therapy process starts with me seeking to understand the person and their issues. After the issues and problems are clearly identified, a game plan is developed to meet the goals of the person seeking help. For example, if a person struggles with anxiety or depression the obvious goal would be to manage it and learn strategies to cope more effectively with those negative emotions. Sometimes people enter therapy because they're having trouble communicating or resolving conflict with their spouse. Again, part of the process involves giving them tools to change their communication patterns and learning new approaches to resolve conflict. Therapy is not just about listening, although active listening is a significant component, more importantly it's about providing specific and effective techniques to improve relationships and emotional well-being. Sometimes when people enter therapy with great resistance, cynicism, and negativity or are confidant that the problem lies with others, the process is more difficult and conflictual. The best way to overcome this reluctance is for that person to talk to someone they respect who has gone through therapy and achieved positive results.

I have found that when there is conflict in a relationship, there is usually blame on both sides. It may be skewed to one party such as 80%/20% but both parties have contributed in some way. So how do you get a person to accept responsibility for their part of the problem? It requires patience, perseverance, and persuasiveness. Sometimes identifying undeniable behaviors that are destructive to any relationship give the person reason for reflection. Sometimes hearing the other person in the relationship take ownership for some part of the conflict helps to lessen their defensiveness. Next, even when the person takes ownership for their problems, often the person does not want to change. People would rather blame than change. Couples are especially good at identifying their partner's flaws but not their own. The therapist's job is to help the couple or individual realize that life will remain miserable until change occurs. Most couples committed to the process will be able to make positive changes and improve their relationship. However, for some couples the change is ultimately separation or divorce. Unless those individuals commit to learning from their mistakes, they may find themselves dealing with the same problems in future realtionships.

While it is important to be compassionate and sensitive to client's problems, it is equally as critical to be honest and direct when identifying their issues. Many have not heard or chosen to listen to negative feedback from friends and family. Hearing the truth from an objective stranger is difficult, but necessary and impactful. People can and do change when they realize the benefits. A good therapist provides the roadmap for change and the necessary guidance to stay on track. Along the journey the person gains insight, strategies, and eventually resolution or at the very least management of conflict. The path is typically not straight, but the destination is life-changing.

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